Home Visit

One of the requirements of the family medicine residency is that we make home visits to two of our patients. I just finished the second visit last week and it was a really wonderful experience. My patient is 81 years old. She has 7 children scattered across the USA. Her youngest son lives with her and takes care of her - including cooking, laundry, cleaning, and help with bathing. For 81, she is pretty spry - both physically and mentally. She walks every day, goes to church every Sunday, and can tell you all about her 7 children, 20-something grandchildren and 12 great-grandchildren. Her medical problems include diabetes, high blood pressure, high cholesterol, and a history of strokes. I first met her in the emergency room in July when she had severe back and abdominal pain that turned out to be shingles. She was looking for a new doctor, and I offered to see her in clinic. I haven't seen her too many times, but the last time I saw her, I thought it would be a good idea to check out her home situation. I had some questions about the management of her medications - it seemed like she wasn't taking some of them as prescribed. Unfortunately, some elderly individuals are not well cared for by their family members. They may be exploited for their social security checks or other assets, or their family members may use prescription drugs for themselves. My patient's son seemed to be very caring, but I wanted to see for myself. I learned a lot about my patient and her family during my visit. The house was adequately adapted for an elderly patient - including wheelchair ramp up to the door, bars on the walls and shower for support, a shower chair, and a low-lying bed to prevent falls. These amenities alone demonstrate the family's willingness to invest in their mother's health. Then again, as I got to know my patient better, I began to realize that she is not about to let anyone push her around or neglect her. She's a tough lady with a strong personality and sense of family loyalty. Even so, there appears to be some discord in the family. Her son feels that the rest of his siblings are not doing their share to help out, despite the fact that one of them lives across the street. He may be too proud to ask for help, but he feels that they should offer. Caregiver burn-out is quite common, even when the patient is relatively healthy. But my patient's son seems to handle the responsibility well. He has some of his own activities that get him out of the house a couple of times a week, and that is probably very important for his mental health. My patient's uncle is a pastor, and she has attended his church for most of her adult life. She is well-loved in her church family, and for her 80th birthday, they celebrated with eight days of honoring her in various ways with treats, cards, prayers, encouraging words, acts of service, games and favorite memories. Her son showed me the photos and commemorative plaque they made for her. In fact her house is adorned with family photos - demonstrating how important her family is to her and how proud she is of them. At the end of my home visit, I asked if I could pray for my patient. We gathered around her - the son, a granddaughter who had come in during our visit, myself and my faculty advisor/preceptor. It was an honor and privilege to pray for this saint - for her physical and spiritual well-being, for her family and loved ones, and for the Great Physician to pour out his blessings on her and through her. I know I was blessed by this short visit, and I believe my patient was blessed as well. I think her son felt encouraged and validated in his efforts. He was able to voice some concerns that we had not addressed in the office. Our clinic social worker attended the visit and was able to provide some advice on resources for home care, equipment, prescription plans and insurance issues, which was a tremendous help. The home visit is so much more intimate, personal, and meaningful than any office visit! I wish it were possible to always see my patients at home, at least once in a while. Although we are only required to do two home visits as residents, I hope I will be able to fit in many more!