House Calls Make a Comeback

House calls may seem like a relic in American medicine, but for Marie Carmel Garcon, DNP, they are a necessary ingredient of contemporary health care.

For nearly five years, Garcon has traveled through Washington Heights and Inwood and provided primary care for hundreds of homebound patients. The House Calls program she leads—created in 2017 by the ColumbiaDoctors Primary Care Nurse Practitioner Group—quickly gained a foothold in the community when it started, and it continues to thrive five years later.

Garcon has cared for patients at Columbia University Irving Medical Center for more than 30 years, also learning the administrative side of nursing—roles she loves.

But her patients’ welfare has always come first, so when she recognized the high rate of re-hospitalization after (primarily) older patients were discharged, she decided to find ways to help them stay out of the hospital.

“I wondered what was going on in their homes that they kept coming back to the hospital and that led me to understand the many barriers they face,” Garcon says.

Many patients did not have the ability to leave their apartments and travel to a doctor’s office, Garcon found, and simply stopped going.

“Knowing this, I didn’t feel as though my mission was fulfilled.”

More than primary care

The House Calls program serves homebound adult patients; currently 150 are in the program.

Garcon visits almost 20 patients a week. She examines each patient and reviews their charts; checks blood pressure, cholesterol, sugar levels, and kidney and liver functions; and manages chronic conditions.

A huge problem for many patients is confusion over their medications. Some patients have multiple prescriptions to juggle, and dosages may become inappropriate if patients lose weight. At each visit, Garcon assesses the situation and makes adjustments.

“It’s like a puzzle,” she says. “It takes a while to get the big picture, but once I have everything set, it’s beautiful. The patient is comfortable, and satisfaction is great.”

When a patient needs to see a specialist, Garcon can often arrange for a home visit. Podiatrists, ophthalmologists, and mental health practitioners have all visited Garcon’s patients over the past few years. Even X-rays can be taken during a home visit.

Telemedicine is playing an increasingly important role during home visits, and even teledental visits are possible. Using an intra oral camera, Garcon can give virtually visiting dentists a good view of decaying teeth or loose dentures. And soon, thanks to a grant Garcon and the Columbia dental team won last year, patients will be able to access in-person dental care more easily when Columbia’s mobile dental clinic rolls down their street.

Garcon also assesses patient’s living arrangements and psychosocial needs and helps her patients access social workers, elder-care lawyers, and home health aides who help patients with cooking and cleaning. Mental health needs are addressed by a psychiatric nurse practitioner from the practice.

“Loneliness and depression all contribute to a patient’s health,” Garcon says. “My background gives me the perspective to see the bigger picture and my network of resources helps make patients’ lives better.”

Help from students

Students in the Columbia Student Service Corps have recently joined the program as “friendly callers,” to help reduce patients' isolation and improve mental health.

Students from the medical, nursing, dental, public health, and social work schools check in frequently with patients. “Their insights have helped us learn a lot about the patients that has improved their care,” says Garcon.

Students in the psychiatric nurse practitioner program make home visits to help with mental health. This summer, Columbia dental students will start accompanying Garcon on home visits as part of their curriculum. Some dental students are already volunteering with Garcon and working on a grant to provide some patients with iPads for telehealth visits.

Impact

Garcon knows her approach is working as data show fewer hospitalizations among her patients and a drop in the need for hospice care, which means more individuals are able to stay in their own homes until the end of life.

Referrals are made via word-of-mouth or from senior centers or neighbors who recognize a friend in need. Garcon no longer sees only patients who have been recently discharged from the hospital. Eventually, Garcon would like to expand the program to include children and pregnant women, adding a pediatric nurse practitioner and midwife to her roster.

“The program makes such a positive impact on patients, and they are so grateful. I can see the changes we’ve made to each one, and they know they can count on me,” Garcon says.

“Nursing is not a profession. It’s a vocation, and there is nothing else I would rather do than take care of the vulnerable and frail and improve their lives.”