Teds PortraitJanuary 6th 2013

What does a Peach have to do with House Calls?


My name is  Dr. Ted Rosenberg or Dr. Ted as some of my patients call me. I look forward to blogging every month about health  and health- care related  issues that affect  elderly people.

PIECH sounds like PEACH. It is  an acronym standing  for Primary interdisciplinary Elder  Care at Home.   That is a mouthful  so we stayed with PIECH, which is also a  metaphor for our practice. Not just warm and  fuzzy,  but juicy, meaty and built around  a solid core.

I believe that house calls by physicians can  improve access to care for frail people.  Many people have difficulty getting to a doctor’s office because of physical problems such as chronic pain, weakness or imbalance. Similarly, mental health problems such as dementia or depression may limit a person’s ability to make and keep an appointment. They may be incontinent during an office  visit causing them embarrassment. Caregivers often have to take valuable time off work to take their family members to the doctor’s office. So, doesn’t it make sense to see people in their own homes?

Home-based assessments can also improve the quality of care.  During a house call, there is usually more time than would be available in an office setting  to assess multiple inter-related problems facing a person coping with many chronic diseases and syndromes.  People are often more relaxed in their homes and I have the advantage of observing  their environment and how they are managing on a day to day basis. Over  the years,  I have looked after many people with dementia, stroke, Parkinson’s Disease, arthritis  and with heart and lung problems. Many  struggle outside their own environment, but manage very well in their own homes. This may not be readily apparent in an office setting.  Family members, neighbors and health care workers’ first impulse may be a  push for the safety of an institution when they see  an elderly person living at risk.  However, institutionalization is usually the last thing an older person wants.   House Calls   and proper home supports  may delay or prevent institutionalization by providing care in the home.  With proper planning and appropriate  care,  many people can stay at home at the end of their lives and die in their own beds.

Most elderly people do not want to be hospitalized when they are ill or injured. We try to recognize and treat acute illnesses promptly and give people choices about where they want to be treated.  Careful attention to management of medications, chronic diseases and syndromes may also prevent acute illnesses and injuries. It is not possible to treat all  problems  in a home setting. Hip Fractures require care by a trained surgeon in an equipped operating room. However, many cases of pneumonia, urinary infections and even heart problems and strokes can safely be treated  at home.  We also believe that people who are competent have the right to choose to stay at home and live at risk,  as long as they are aware of these risks.

We also think that people get better  assessments and care when it is delivered by an integrated Team of professionals.  Each Team member has a unique perspective on a frail elderly person. This interdisciplinary assessment is  akin to  taking a picture of a person from different angles. The resulting picture is richer and often more accurate.  A physician,  nurse, physiotherapist, dietitian or other professional also brings a unique set of skills to improve peoples’ health status.   Health care and  health status can be improved by integrating this care into one Team with the elderly person and their caregiver at the center.  Communication is essential to a highly functioning Team.  We encourage patients and family members to contact us by phone or  email  when they are concerned about a change in  their health status. This way we can respond in a timely manner avoiding further deterioration and trips to the hospital.

In conclusion,   these are some  of the things that  a Peach  has in common with a PIECH.  In this monthly Blog,  I will try to share my experiences from patient-care and information that I have  gleaned from  research about  ways to maintain and improve your health.

Stay Informed and Healthy,

Ted Rosenberg MD


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