Advanced illness home care

Thanks very much for this short review and plea for advanced home care as a positive, engaging, challenging practise style. I very much agree with your points.

I did what I called House Calls for Frail Elderly for the last 4 years of my family practise, and retired one year ago, having been able to recruit a young woman physician to take over the practise. For my model, I used the framework of frail elder care developed in 2012 by the MoH, and I drew on the work of Dr Mark Nowaczynski in Toronto. I did indeed find the practise rewarding, challenging, interesting, and quite doable.

I found that about 15% of the practise was actively palliative at any given time. Everyone had to meet criteria of frailty and chronic illness. Also, about 15% of visits were acute care. I had to make sure I had open slots each week to accommodate the types of appointments, and that was important in order to stay on time and to finish the day at a reasonable time. The office allowed me to stay a member of the FHO so that my appointments were made through the office, my Billings were submitted through there, and, most importantly, the server kept my electronic charts. I charted on a laptop, using remote connection to the server, which only failed me in remote areas from time to time.

I did accept patients by referral, then rostered them into the Family Health Organization of the Family Health Team in Cambridge, Ontario. I pored over the billing pages of the OMA and OHIP billing manual, and learned to think of the practise income as an annual one, rather than a fee for service income. The income was entirely comparable to what I made in the office. I also had a much lower overhead. Because of being with an FHT, my patients enjoyed the benefits of diabetes care, nursing triage, clinical pharmacy support and consults, and occupational therapy. Our team has a Memory Clinic, also a useful resource for this group.

I also think that AIHC is an unmet need in many communities, and would love to see it promoted as a practise option. I think it is a full time practise, and requires some special skills, which are not difficult to learn. Palliative principles, care of the common chronic diseases ( heart failure, cold, arthritis, diabetes, dementia, Parkinson’s, MS, ALS and so on), as well as communication and compassion. I worked with a wonderful team which included the CCAC people, the FHT people, and the hospital ER, as well as the specialists, with whom I used those cool phone consult codes when I needed help or confirmation, as the case may have been.