The Benefits of Using Your Adult Family Home’s Visiting Doctor

This question often comes up during a loved one’s move to an adult family home: 

“The adult family home has offered to enroll my mother in their home-visiting doctor program, but I’m hesitant to change doctors. My mom’s doctor has been with her for years and knows her very well. What should I do?”

A number of adult family homes in the East King County, WA area offer home-visiting doctor services and I would highly recommend making the change and enrolling your loved one. Here’s why:

Seeing the Whole Person

The home-visiting doctors are typically Advanced Registered Nurse Practitioners (ARNPs). Maybe I’m partial since I’m an RN myself, but nurses’ training really looks at the whole person and evaluates what is going on, not just medically, but mentally and emotionally as well (i.e. do they have severe dementia, depression, or anxiety?) They are also very realistic about goals of care for each individual client.

More Time With Each Resident

The ARNP (or home-visiting doctor) typically visits the home about every 4-6 weeks. If folks are very stable, the time between visits may be longer. They spend between 30 and 90 minutes with each client, and the client’s family is welcome to be present. They tend to look at risk vs rewards related to medication and treatment a bit more strongly than an MD might, and will take the time to explain things to the family and client. 

A Clearer Understanding of Daily Health Needs

Home-visiting doctors come to your loved one and see them in their own surroundings. They can hear directly from care staff how nights are going, how your loved one is eating and sleeping, and how all bodily functions are doing. They get a very good picture of the client in a relaxed setting so when blood pressure is checked, it is likely to be a normal reading, not artificially elevated due to the anxiety of being in a doctor’s office. Plus, the client is not exhausted from traveling and waiting to be seen in the waiting room - they are relaxed and comfortable. Not to mention, you will limit the exposure to the other patients in the waiting room who may have a contagious cold or flu.

Awareness of Medication Regulations

When home-visiting doctors write orders, they understand the regulations that adult family homes must work within. Doctors in regular practice often do not understand the unique state requirements for the way these orders need to be written. The result? The staff, nurse delegator or family members may spend many extra days actually getting the doctor to write the order correctly for the adult family home setting.  This tedious follow-up can delay the client receiving intended medications.  

A good example of this type of problem is an order that comes from an MD office that reads:

Acetaminophen: give 1 – 2 tabs by mouth every 4-6 hours as needed for pain.

Well, this may be ok if you are in your own home and you don’t have to comply with specific regulations, but in the adult family home this order can’t be followed. The Acetaminophen must have a strength listed: is it 325mg? 500mg? 650mg? It must be clear whether the caregiver care giver should give 1 tab or 2. And dosage timing must be specific: give every 4, 5, or 6 hours? 

It may take several days just to get the MD to write an order like this one correctly to meet the requirements of the adult family home. The home-visiting doctors, however, are well aware of the regulations in the adult family home and will write the order correctly the first time; no wasted time, no keeping the client in pain while the order is clarified by the MD. Plus, the risks vs. rewards of medications and treatments—along with the goals of care—will be reviewed, topics rarely discussed with the regular MD during busy office visits.

Faster, Easier Access to Care

Another benefit of a home-visiting doctor is their ability to take care of multiple issues that other MD’s may refer out to a specialist. For example, many of the clients I see in my nurse delegation work have skin growths. Some are large skin tags that get caught on clothing and are uncomfortable. They often can be frozen off (with histofreeze) and will simply go away after a treatment or two.

If you inquired about something like this at an MD visit, the doctor would likely give you a referral to a dermatologist, which may require waiting a month for an available appointment. So now you're making another exhausting trip out to have it frozen off. The home-visiting doctor could've could have done the same thing right away, but instead you've spent weeks waiting and hours of your day.

Or, perhaps your loved one has impacted cerumen (wax) in their ears and you can tell their hearing is decreased. If you mentioned this at the MD office, the MD would refer you to an Ear, Nose and Throat specialist. You may get in to see that doctor within the next month or two…then could finally have that wax removed. Instead, most of the home-visiting doctors are equipped to remove ear wax on the spot. Sometimes they will prescribe ear drops to soften wax prior to their next visit and then at the next visit the wax will be removed: no fuss, no travel, no setting up new paperwork at yet another doctor ... all handled onsite at the adult family home.

Less Stress on Families

Another benefit of using the home-visiting doctor is that you do not have to take time off of work or out of your day to come to the adult family home, carefully load up your loved one, possibly lift a wheelchair into the back of your car and then drive in King County traffic to the appointment. You have the gift of extra time by using the home-visiting doctor. If there was ever an EASY BUTTON, this is it.

You can still be present and involved in your loved one’s care, but you simply come to the adult family home and join in the appointment. No difficult transferring of the client into and out of the car, no lifting, and no waiting in a crowded waiting room with coughing, sneezing people. You get to come to the adult family home, visit your loved one and spend quality time with an ARNP who really looks at the whole picture and what is best for this client. 

What Families Gain from Using the Home-Visiting Doctor

It is understandable that you may feel sad or uncomfortable about ending a relationship with a doctor your loved one has had for years. That said, here's what families gain when they make the switch:

• The staff at the adult family home gets to actively participate in the visit. They can share what they see 24 hours, daily. 

• You can be as involved or uninvolved as you desire.

• Your loved one is not stressed by an outing, transferring into and out of the car or having to walk far for an appointment.

• The home-visiting doctor understands how the adult family home must function and will work within their regulations, writing orders correctly so there is no wasted time between getting orders and actually being able to provide those to the client.

• Home-visiting doctors accept Medicare so this is not going to cost any more than it would going to your previous doctor.

Putting Your Loved One’s Comfort First

As your family helps your loved one settle into an adult family home, we encourage you to use the home's visiting doctor. They see your loved one in their actual day-to-day life, not just for 15 minutes in an exam room. And that usually means better care and a whole lot less stress for your family.

Need help finding the best adult family home to fit your loved one’s particular care needs? I specialize in elder placements within adult family homes in East King County, ensuring your family experiences a calm and caring transition. Let me know if I can help you and your family.