Physician Home Visits – Case Report #1
The daughter of an 81 year old male was asked to call me by her father's physician because he could no longer navigate the stairs of his walk-up apartment to go to the doctor's office.

The patient has an underlying dementia and lives with a 24-hour aid. The daughter lives almost an hour away from her father.

The patient had recently been discharged from the hospital after having sustained a pelvic fracture from a fall in his home. The pain was treated with Percocet. Since discharge from the hospital, the patient's mental status had regressed, whereby he no longer would walk to the toilet, would not go down the stairs of his apartment, and would suddenly get angry without known provocation. Worst of all, however, was that he was now putting his hands up his rectum and smearing his feces around the house. The home health aid was not able manage this behavior, and was instructed by the daughter to tie his hands together.

I went to visit the patient and found his hands swollen, cold, and red, from having been tied together. He exhibited delirium (confusion and agitation superimposed upon a stable dementia), and his blood pressure was elevated.

I ordered medication to clean out his colon, and within 24 hours, he had stopped smearing his feces around the house. Since the delirium and high blood pressure were still an issue, the daughter elected the telephone consultation service to further manage these symptoms. Within 2 weeks, the patient was going down the stairs to his physician's office.


Physician Home Visits – Case Report #2
The daughter of a 96 year old female was asked to call me by her mother's physician because she was not well enough to go to the doctor's office. The patient had recently been discharged from the hospital for treatment of congestive heart failure and hypertension (high blood pressure).

Though I shared several suggestions about medication management for her heart failure and blood pressure, the daughter appreciated the most my suggestion to go on hospice. Though her mother was not actively dying, she did meet criteria for hospice, and hospice would provide the much needed home health aid once Medicare stopped home care services. The daughter was educated on the services and duration of services hospice would provide in the home, the symptoms to emphasize so the hospice agency would accept the patient, the name and telephone number of the hospice, and the guidance not to agree to start hospice until the hospice agency was sure they had a home health aid ready to start.

The patient was accepted to hospice, but since a home health aid was not immediately available, the patient remained on the Medicare home care service until the hospice aid could start.