Providing medical care to senior patients in the comfort of their homes

Terry McCabe spent much of the past year in and out of the hospital as he dealt with prostate and kidney issues and two episodes of sepsis (a potentially life-threatening infection), one of which kept him in MaineGeneral’s Alfond Center for Health for a month. He also was hospitalized last summer after a heart attack.

The 86-year-old Farmingdale resident finds navigating stairs and uneven surfaces difficult, which makes getting to doctor appointments a significant challenge.

Thankfully, he can receive ongoing medical care in the comfort of his home because of Maine Dartmouth Geriatric Medicine’s home-based primary care program.

Once a month, geriatric specialist Dr. Carlen Smith visits him to do an exam, review his medications, discuss his medical conditions and answer any questions he and his wife Lorraine may have. These visits have helped to manage Terry’s overall health and wellness and prevent additional hospitalizations.

“Dr. Smith has a good bedside manner and takes very good care of me,” Terry said. “She makes recommendations and is a good listener. I’m very happy to have her.”

“It’s a Godsend because he can sit in the privacy of our home and have a nice one-on-one conversation with the doctor. That’s a rarity in medicine,” Lorraine noted. “In geriatric care, it’s critically important because patients are older and get confused more readily.”
“People can’t believe it when I tell them she comes to the house because that’s old-school doctoring,” she added. “It’s remarkable what they’re doing with that program.”

Providing a unique service

The home-based program grew out of Maine-Dartmouth Family Medicine Residency’s Geriatric Medicine Fellowship, which Smith completed in 2020.

Fellows are required to make home visits with Maine Dartmouth Geriatric Medicine patients as part of their education and Smith was passionate about that aspect of the program.

“Home visits were one of my favorite things to do, even beyond what we were required to do through the fellowship,” Smith said. “The medical director at the time allowed me to expand and formalize the program, which is what we’ve spent the last two years doing. We have grown it into a really robust home-based primary care program.”

Smith and colleagues Olivia Simpson, MD, and Isaiah Meyer, AGNP, collectively visit with patients in their homes five days per week, caring for patients throughout the Kennebec Valley region. They are supported by an RN triage team, medical assistants and patient services staff who schedule the visits and do all of the necessary work before and after each one.

“We have a combined panel of 140 patients to visit,” Smith said. “Essentially these are homebound patients who have difficulty getting out.”

Visits are much longer than a typical office appointment, about an hour by comparison, and involve just the clinician and the patient and their caregiver. In addition to their primary reason for being there – the medical appointment – the visits also allow them to assess other issues.

“People often will offer to have us walk around their house, which allows us to do a visual assessment of trip hazards and fall risks,” she said. “We also may see that there’s not a lot of food in their cupboards or fridge, or other things we wouldn’t know without visiting them at home.”

Meeting a growing need

Smith and her peers recognize the importance of their program, which continues to expand in response to a growing need.

“We know Maine’s older population is going to explode and there aren’t enough nursing homes, assisted living facilities and dementia care facilities to handle all of it,” she said. “So we’re really asking people to age in place at home. If we can keep them there and avoid unnecessary emergency department visits, hospitalizations and transitions of care, that should be our goal.”

Smith said the community response to the program has been extremely positive. She and peers are equally pleased.

“It’s a privilege to go into people’s homes to do a visit,” she said. “It’s incredibly rewarding, especially when we have an outcome that the patient is really satisfied with.”

To learn more about the program, please call Maine Dartmouth Geriatric Medicine at (207) 626-7400.