Almost 2 million older adults are completely or mostly homebound, and another 5.5 million are semi-homebound — i.e., they are dependent on others or have difficulty leaving the home. The homebound are a vulnerable, multimorbid, functionally impaired, high-need, high-cost population. They experience substantial mortality — approximately 20% – 40% over 2 years, depending on the degree to which they are homebound.
In the wake of health care reform and growing interest in value-based care, models of home-based medical care — including both home-based primary care and home-based palliative care — have emerged as clinically effective and cost-saving evidence-based models to care for high-need, high-cost patients like the homebound.
This slide describes the unique approaches to care: longitudinal care in the case of home-based primary care and (mostly) consultative care for home-based palliative care, and the overlapping provider skill sets and functions of these approaches in the service for homebound patients. The provider skills noted in the left side of the figure depict home-based primary care–specific competencies outside the usual sphere of palliative care needed to serve homebound persons. The skills listed on the right side of the figure depict specialty palliative care skills that are sometimes needed in the care of homebound persons and should be available to them.
The sweet spot in the middle of the figure highlights competencies in primary palliative care that home-based primary care physicians should be proficient in. Given the range of needs of the homebound, the figure also provides visual representation of the rationale for the development of home-based medical care delivery models that encompass both primary care and palliative care skill sets.