Long‐Term Home Health Care for the Impoverished Frail Homebound Aged: A Twenty‐Seven‐Year Experience

Abstract

The Chelsea‐Village Program (CVP) is a long‐term home healthcare program for a largely isolated and impoverished frail homebound aged population, based at Saint Vincent's Hospital in New York City. Since January 1973, our CVP teams of physicians, nurses, and social workers have cared for the homebound aged over the long term. Twenty‐seven years later, we have made 42,866 home visits to 2264 persons in lower Manhattan, an area of New York City housing a high concentration of older people. Our purpose is to help our patients remain in their own homes and community at the maximum possible level of personal control and to maintain the best attainable health. Additionally, the program is a valuable component of the Hospital's Primary Care Adult Medicine residency program. It also serves as a laboratory for the study of health problems faced by the homebound aged and the solutions to these problems. The program, a medical‐social model, has required modest philanthropic investments, dedicated service by physicians, nurses, and social workers, and the support of a hospital with a strong charitable mission. The CVP experience has encouraged the creation of other long‐term home healthcare programs across the country, including the Medicaid‐supported Nursing Home Without Walls program that spans New York State. Thus, the CVP can be viewed as a model rather than an idiosyncratic non‐replicable phenomenon. As such, the program has established that multidisciplinary healthcare teams, in collaboration with a teaching hospital, can provide long‐term home health care to homebound older people in the local community. Moreover such a practice is mutually beneficial. J Am Geriatr Soc 48:1002–1011, 2000.

Brief Communication: National Quality-of-Care Standards in Home-Based Primary Care

“…The modifications, deletions, and additions made during the study demonstrate the unique challenges and preferences of homebound seniors (7)(8)(9)(10). More than half of the eliminated indicators were from the treatment domain of care.…”

“…These quality frameworks, however, cannot be simply adopted. Home-based primary care patients have higher mortality rates and shorter life expectancies than the ACOVE-studied populations, with goals of care that focus on quality, rather than prolongation, of life (7)(8)(9). Home-based primary care programs are often multidisciplinary efforts that emphasize coordination and continuity of care (10).…”

La hospitalización domiciliaria: antecedentes, situación actual y perspectivas

“…Dada esta realidad, la mayor parte de los estudios sobre el tema prevén un aumento de los servicios de atención domiciliaria y señalan que los sectores sanitario, social, político y económico sitúan la HD como una alternativa asistencial muy halagadora, viable y prometedora (6,(24)(25)(26).…”

“…No obstante, la mayor parte de los autores resaltan la necesidad de una mayor colaboración entre los servicios hospitalarios y extrahospitalarios (atención primaria, ambulatoria y domiciliaria y servicio social) para posibilitar una asistencia continua y eficaz (11,23,24). Dicho de otra forma, es imperativo adoptar una nueva filosofía asistencial que busque modernizar los sistemas sanitarios, procurando convertirlos en modelos integrados de salud basados en una responsabilidad compartida (5,25,26,41).…”

“…Esta situación crea cierta tensión entre profesionales y niveles asistenciales, llevando a círculos viciosos difíciles de controlar desde la forma como se estructura la organización sanitaria actual (9,25,28,64). Cabe mencionar que tanto la atención primaria como la atención hospitalaria tienen su espacio en el ámbito domiciliario.…”