Advances in mobile health care help the elderly


Most dentists stay in their practice. But some make house calls, including Charles Doring, a dentist in Rockville, Maryland, who travels equipped with a portable cabinet on wheels carrying a portable x-ray machine, compressor, suction machine and his headlamp.

Mobile dental units have sprung up nationwide, many of which are geared towards the elderly, including some that serve assisted living and nursing homes. But they don’t usually visit private homes.

California dental professor Paul Glassman proposed a different approach, called the Virtual Dental Home.

It uses telehealth to connect dentists in their offices with dental hygienists who can visit patients at home, said Glassman, associate dean of research and community engagement at the College of Dental Medicine at California Northstate University at Elk. Grove.

Laws governing the role of hygienists vary from state to state, but in some states, including California, they may obtain special licenses allowing them to treat housebound patients with temporary fillings.

Medicare does not cover most dental care and procedures, including cleanings, fillings, extractions and dentures. Some of the Medicare Advantage plans include treatments, so take a close look to see if dental care is covered in your plan.


Miriam Godwin is director of health policy for the National Kidney Foundation, based in New York City. Most U.S. residents with irreversible kidney disease need to go to a dialysis center for treatment, she wrote in an email.

“The United States has much lower home dialysis rates – around 15% – than other developed countries, where home dialysis use can approach 80%,” Godwin said. But in hopes of turning the tide, the previous administration had set a target of 80% of patients on home dialysis by 2025, she said.

The two main types of dialysis are peritoneal dialysis and home hemodialysis. Prescriptions – how much dialysis a person receives on what schedule – can be personalized to fit a patient’s schedule and preferences.

Who benefits the most? “Really anyone who doesn’t want to prioritize going back and forth to a center three times a week,” Godwin said. This can include people with families, those who care for family members and those who work, “she said, as well as students and frequent travelers.”

Patients were particularly vulnerable to COVID-19, due to their underlying health issues and because most of them had to rely on dialysis centers, where social distancing was difficult, Godwin said .

Medicare pays most of the dialysis costs, but it does not cover the costs of staff to help dialysis patients at home. Securing that reimbursement is a key goal of the National Kidney Foundation, Godwin said.

Sample collection

Nathan Cron is the president of a non-profit company that collects blood, stool, urine and sputum samples. His company, the Las Vegas-based National Phlebotomy Provider Network, connects patients with technicians who visit patients at home to collect samples to be tested by separate labs.

“Since the start of the pandemic, interest in and use of our in-home sample collection services has increased dramatically,” Cron wrote in an email.

His company’s clients include Kaiser Permanente, residential care facilities and thousands of individual patients.

Other major advances in home care

X-rays: Portable x-ray machines have grown in popularity and quality in recent years, allowing patients to stay at home rather than waiting in a busy emergency room. Medicare will pay for portable x-rays if certain conditions are met.

Intravenous treatment: It may be necessary when a patient returns from the hospital after receiving high doses of antibiotics, anti-nausea medications, or extra fluids. A nurse can come to the house to administer the medication. Or a caregiver, friend or even the patient can learn how to use IV equipment. Medicare will pay for home infusion equipment, supplies, nurse visits, caregiver training and monitoring.

Chronic care management: Medicare pays clinicians for care management services provided to patients with two or more serious chronic conditions – for example, arthritis and diabetes – that are expected to last at least 12 months and whose care is expected to last that long. These services are classified as medical services under Medicare’s fee-for-service program, so the patient is responsible for 20% of the cost (unless the patient purchases additional insurance to cover the cost. miss to win).

A physician typically manages the patient’s care, lists the patient’s health issues and goals, and develops a comprehensive care plan. The doctor can coordinate with a home care agency that sends home caregivers.

“It is of great benefit to make sure that the primary care physician, home care agency and other providers are all aware of changes in the condition of patients, such as changes in medications, recent falls, recent emergency room visits or ongoing treatment for a chronic illness, ”said Zach Gaumer, a Washington, DC-based medicare policy expert

Help for people with chronic illnesses is available from the National Association of Chronic Disease Directors in Decatur, Georgia, whose website offers tips for things like measuring your own blood pressure and talk to your doctor about a cancer diagnosis.

Note: Check with your health care provider that the treatments listed here are covered by your health insurance plan. The American Academy of Home Care Medicine maintains a online guide home care practices and providers in each state.