My client was overwhelmed by the decision facing her: should she agree to have her 90 year old Mother put on a respirator to assist her breathing. My client’s daughter turned to me and said, “What would you do if it was your Mother?”
A healthcare advocate is frequently asked this type of question. It is usually at a deeply personal moment in the life of our client and their family, and it demands very careful consideration before responding. Why so careful? Because it is of limited importance what I would do in a similar situation, but it is of greatest importance that my client’s family use the resources and decision-making abilities they have to make their own decision. I would not want to sway their decision by inserting my ideas, values and decision into their process. No healthcare advocate should. At the end of the day, I will walk away from that decision-making situation, but my client and her family will live with it every day, for the rest of their lives.
So what did I do? I said, as gently as I could, that these decisions are difficult to make and that I would like to review with them any information or statements they could remember about what kind of care their Mother would want in this kind of situation. I would help them arrive at a consensus that would fit for them. That is truly “what I would do”.
Fifty years ago, I would “tag along” as a child with my physician-father as he made house calls to his patients. We lived in a rural community, and some of his patients paid him with eggs or produce from their farms. These visits were a revelation to me, even at that age. I could see how quickly my father could view the entire range of conditions that his patients experienced each day. Was the home clean? Were there obstacles they could trip over? Where were the drugs kept? Was there food in the home? He would often say to me that he could see in five minutes in a patient’s home what he might never discover while they were sitting in his office.
Today “house calls” are coming back, possibly to a location near you. While they are currently set up primarily for elderly patients who have difficulty going to a doctor’s office, it will be interesting to watch the trend. According to a recent article in Johns Hopkins newsletter “Health after 50” (www.johnshopkinshealthalerts.com/health_after_50) there are more than 4,000 physicians nationwide that provide this service. Under Healthcare Reform, there is a provision for a pilot program, called “Independence at Home” which will attempt to provide home based care to frail and elderly patients. We are cycling back! To learn more about the “house calls” program, visit the American Association of Home Care Physicians (www.aahcp.org). They have a “Physician locator” on their web site, so you can locate a physician for an aging parent or someone on Medicare. The premise–that it is more cost-effective to provide care to people at home if they are unable to go out and, therefore, might skip appointments—it’s an idea whose time has come (again).