The doctor is in

Tigard healthcare provider brings back good old-fashioned house calls

If it’s true that “an ounce of prevention is worth a pound of cure,” then consider David Harris living proof.

Harris, who lives in Metzger, has been in the emergency room more times than he can count.

In 2015, Harris went in to manage his lung problems, his heart problems. He went in after taking a bad fall. He went in to handle general pain maintenance and to get prescriptions refilled. He went in often.

But Harris hasn’t been to the emergency room at all since last July.

“My life has changed for the better,” he said.

The reason, he said, is simple. It’s thanks to a new Tigard healthcare organization that offers in-home services for the chronically ill.

Landmark Health began servicing Tigard and the surrounding Portland area last year. Its Portland headquarters is located near Washington Square mall, though the company is based in Huntington Beach, Calif.

The company provides in-home healthcare to frail and chronically ill patients. Nurse practitioners visit patients in their homes in-between their regular doctor’s visits.

The hope, said vice president and general manager Jill Donovan, is that by treating small problems with patients as they arise, Landmark can keep patients from needing to visit the emergency room.

“Prevention is far more cost effective than reaction,” Donovan said.

Landmark spokeswoman Lisa Scholin said that for chronically ill patients, treatment isn’t a simple procedure.

“There are needs between appointments — often urgent — that can quickly turn into a cycle of trips to the ER or hospital that are expensive and hard on someone who is older or very ill,” she said.

But while medical house calls may seem old fashioned, Landmark is finding itself part of a growing industry.

The home healthcare market was valued at nearly $757 million nationally in 2014, according to market research firm Grand View Research. That number is expected to grow to more than $839 million over the next decade.

Many people with chronic illness rely on emergency rooms in order to get their basic medical needs addressed, said Harris’ nurse practitioner Rachel Prusak.

“Say your primary care provider leaves and you don’t have another,” Prusak said. “You still need refills for your medication. Where do you go? You go to the emergency room.”

Harris lived in Northeast Portland for years, but moved to a senior care facility in Metzger after a hospitalization.

“She saved me a couple of times,” Harris said about Prusak. “I would have ended up calling 911. I hate it, but that’s what you have to do sometimes.”

Harris has called Prusak for urgent visits when he’s experiencing problems, but Prusak said that most of her work is about preventative care.

“If you can get ahead of the problem, that’s our goal. If we see any signs, we can get to it before it’s urgent.”

During her weekly visits, Prusak checks Harris’ heart, his lungs, his weight. She asks him how he’s feeling. In her car is a tackle box filled with medications.

“If we need to do a bolus (a single dose of a drug or other medicinal preparation given all at once), I can do it, instead of sending him to the doctor’s office,” Prusak said. “That keeps him happy at home and gets him treated.”

Prusak helped Harris find a new doctor after he moved, and keeps in regular contact with his other medical providers and social worker.

“I’d go into David’s home and find him hours after he’d taken a fall. I’d find bruises and cuts and scrapes. I’d clean him up and help prevent infection.”

The relationship between Prusak and Harris goes beyond just medical.

When Harris decided to move into a senior care facility, Prusak helped him find a place to move.

“Part of our social work is meeting the needs that they have,” Donovan said. “For David, that was finding him this place.”

Landmark is starting small. So far, only about 2,500 Medicare Advantage patients in the Portland area are eligible for its service through Health Net in Oregon, though that number is expected to rise, Donovan said.

It’s not uncommon for hospitals to offer a limited amount of in-home healthcare to patients after they are discharged, Donovan said, but they don’t have the capacity to stay with those patients for months or years.

“Doctors in a hospital can’t see what David is tripping over, or how many scrapes and bruises he has after a fall. Rachel can. She can help put plans together because of that,” Donovan said. “A hospital may have patients get in-home healthcare to make sure they get their meds, but nobody is there making sure those meds got re-filled or that they are taking them at the right times. That’s the key for us.”

https://www.pamplinmedia.com/ttt/89-news/298171-174215-the-doctor-is-in