I met with Dr. Reva Adler, medical director of the Home VIVE program in Vancouver, a couple of weeks ago. Home VIVE is a very effective primary home care of the elderly program that took over most of my home care practice a few years ago. Its three doctors, and nurses have been doing a wonderful job.
Reva shared with me some interesting numbers. Taking about 130 patients from one of the physicians, and comparing their visits to the emergency room during approximately 2 years before the program, and during one year after it started, there was a very marked reduction in use of the ER. Reva figures approximately 73 emergency room visits were saved by that portion of the program during that time.
I’m particularly impressed that the program that was studied has a group of geriatric-oriented family physicians who don’t know the patients, on call during weekends and at night. This to me means that if health professionals familiar with the patients, or at least able to access their records, were responding to out-of-hours calls, the improvement in hospital utilization would be even better.
Readers of this site will understand that I am no fan of a lot of what passes for science where the frail elderly are concerned. The quality and “generalizability” are usually not very good. But here we have at least something that looks scientific saying that when we do good responsible primary care for frail people at home, we keep them out of the hospital. With any luck, this kind of information will add credibility to the mountains of experience and common sense already telling us that we need to move in the direction of primary home care, and it might even get the attention of decision-makers. Imagine if frailty care were actually coordinated, across the whole system!
Congratulations Reva and Home VIVE for helping to lift the burden off our acute care hospital system, and for proving it.
Dr. Reva Adler commented in an e-mail that “Home-ViVE has been a success due entirely to the work of Lesley Nicholson and the Home-ViVE team: Gisela Jaschke, Conrad Rusnak, Jay Slater, Rod Ma, Lydia Pobodnik, Maria Alberto and Hester Chan.” Admirable self-effacement on Reva’s part, but certainly everybody mentioned deserve to share in congratulations.
While fully agreeing with the philosophy of Home VIVE, I am even more interested that its seems a practical business model.
It will be win-win-win if the Home VIVE people can make a decent living serving these frail elderly patients PLUS keeping some ER and acute beds free, as well as giving the elderly patients more appropriate care (as you describe in ‘A Bitter Pill’).
A fourth ‘win’: with Home VIVE the elders’ caregivers have a team to call on, giving them a much better chance of reaching the help they need whenever they need it. That would be an important support during the difficult last years.