Visits keep frail elderly out of hospital.
An interdisciplinary team from Boston University's Geriatric Service provides home visits for frail elderly patients who are homebound. The home care team includes a nurse case manager and a board-certified geriatrician. Physicians visit the patients every two or three months. Case managers visit as needed. Case managers use creativity to come up with ways to keep the elderly at home, including providing pest control, air conditioners, or chair lifts. The program coordinates care across sites of care, including a geriatric outpatient clinic, nursing homes, and an inpatient geriatric service, as well as the home visits.
D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D006299:Health Services for the Aged / Q000458:organization & administration; D006760:Hospitalization; D006792:House Calls; D006801:Humans; D019982:Organizational Case Studies