Visiting Physician Stresses Importance of Advance Care Planning During COVID-19
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It’s 7:15 am and Dr. Sara Leonard prepares for the day’s visits: Take temperature. Check. Complete self-symptom screen. Check. Gather personal protective equipment. Check. Replenish cleansers and sanitizers. Check. Dr. Leonard is ready to begin her house calls in the world we now know as COVID-19. She jumps in her car at 8:00 am and heads to Fair Lawn for a routine home visit to evaluate a patient’s blood pressure and renew prescriptions. At 9:30 am Dr. Leonard heads to Paramus so she can discuss lab and EKG results with a patient and his daughter. At 10:45 am she’s back in the car to call on a patient in Englewood who seems to be having a flare up of COPD. Dr. Leonard orders a chest x-ray to be performed in the patient’s home. And so it goes in the life of a house call physician.
While many primary care physicians have had to close offices during the pandemic and rely on telemedicine, VNA Health Group’s Visiting Physician Services (VPS) has remained open doing what they do best: making house calls to homebound adults and the frail elderly. In-home visits have been a saving grace for this vulnerable population that is most at risk for the coronavirus. They are fearful of going out of the house, afraid of landing in the hospital and not returning home.
Dr. Sara Leonard, Medical Director for Visiting Physician Services, comments, “It’s an extremely scary time for homebound elderly people in New Jersey and those who love them. House calls are challenging on an ordinary day but this virus has added another layer of worry and uncertainty. I’m proud to be part of a team of 40 physicians, physician assistants and nurse practitioners who are out there every day making house calls to these homebound individuals. They are counting on us to keep them safe and well.”
For many geriatric patients who increasingly struggle with trips to the doctor’s office or clinic because they have mobility issues, chronic illnesses or simply are unable to leave the home, a visiting doctor is a lifeline, enabling them to receive comprehensive care without leaving the comfort and safety of home. These home visits can also provide a major relief for caregivers, whose burden is lessened when they no longer need to arrange transportation for routine checkups and tests, or worry about how they are going to get a sick loved one out of the house safely.
There’s another and much deeper benefit to the service: Seeing these patients in their everyday surroundings enables VPS clinicians to take a holistic approach in tailoring an individualized care plan to the patient’s life, needs and history. Says Leonard, “Being in the home offers insight into key social and environmental factors that may be missed in an office or clinic setting. It allows us to see the bigger picture which results in providing a greater scope of care for our patients; most of whom are living with multiple, chronic medical conditions such as diabetes, heart disease or dementia.”
VPS becomes the primary care provider, taking a comprehensive and therapeutic approach that ensures patients stay as healthy as possible. This includes helping to keep patients out of the hospital and emergency room. With some nursing homes limiting new admissions in light of COVID-19, house calls are another healthcare option for a loved one who needs long term care. House calls combined with other supportive in-home services might be a solution for some families.
Despite the pandemic, Visiting Physician is able to arrange for a variety of additional services which includes in-home bloodwork, X-rays, EKGs and more. They work very closely with the VNA Health Group and other agencies to coordinate services such as physical and occupational therapy as well as mental health counseling all of which have now gone virtual. Caregivers can count on the staff to help order new medical equipment like hospital beds and wheel chairs that might be needed in the home.
And for those patients who are not quite ready for in-home visits just yet, VPS offers Telehealth. “Adding telemedicine to our house call services was a natural and necessary fit given the high level of fear and anxiety right now. Being able to connect with our patients face to face through video is an alternative way for us to follow up and provide care in between our in-person visits”, says Leonard.
Linda Golub, Physician Assistant with Visiting Physician for 20 years comments, “The COVID-19 crisis has really taken a toll on my patients who mostly live alone or with a spouse or aide. It’s very scary for them as it is for us. But my patients seem to get some comfort when they see a familiar face or hear my voice on the phone to let them know we are here for them. It goes a long way in putting their minds at ease. We reassure them that we’ll get through this difficult time together and that better days are ahead.”
House calls are not for the faint of heart. It’s exhausting but truly rewarding work with the potential to make a difference in the lives of so many people. Concludes Leonard, “It’s more than just medical care we are providing. We form bonds with patients and those who care for them at home. You become like family and you put your heart, mind and soul into it every day.”
Visiting Physician Services provides services in eight New Jersey counties and accepts Medicare and Horizon. For more information, please call 732-571-1000 or visit www.vnahg.org/vps.
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Since the beginning of this Covid-19 crisis, it has become challenging to offer mental health services to our elderly and younger disabled clients. Many of our clients have experienced an exacerbation of anxiety and depression due to increased isolation and loneliness. In addition, we have family members who are also suffering greatly because they are not allowed to visit their loved ones in nursing homes and assisted living facilities.
Medicare has relaxed some of its rules about how these sessions can take place. We are able to provide telehealth psychotherapy services via the telephone at this time. We have instituted this practice for most of our psychotherapy clients if they are comfortable with it.
Generations is happy to help during these difficult times. Please call (866) 353-3726 for further details on virtual psychotherapy sessions.
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