Keeping the elderly out of the emergency room

House Calls may become the standard of care


She may be 97, but Elizabeth Engle isn’t one to let the world pass her by. Still living in her Brookville house, which she and her late husband built in 1962, she passes the time doing puzzles and reading. “That’s why I have all my faculties, because I’m always learning,” Engle explained. “I just read a book about the New York Public Library.”

You can tell from the tone of her voice that Engle takes great pride in keeping her mind sharp. Unfortunately, trying to stay healthy has been a lot more challenging for the nonagenarian.

A few years ago, Engle contracted a debilitating case of double pneumonia, and was in and out of the hospital more than a dozen times. Then one of the nurses helping her mentioned a Northwell Health program called House Calls that provides in-home health care.

House Calls is a home-based primary care program for homebound people, generally the elderly, who find it difficult to access traditional services because of their medical conditions.

Patients receive coordinated care, similar to treatment and referrals they would receive from a primary care physician, including ultrasound, radiology, electrocardiograms, sleep studies, lab work, physical exams, occupational and speech therapy, social work services as well as intravenous fluids and prescription refills.

The House Calls team is also accessible 24/7 to answer clinical questions from patients and caregivers or arrange urgent services.

If a patient needs an urgent evaluation, a paramedic, under the guidance of a physician, will help decide whether treatment can be provided at home or if the ER is necessary, said Dr. Karen Abrashkin, 37, the medical director for the program.

“We’re essentially the eyes and ears of the House Calls doctor,” said Cono Cimino, 36, of East Northport. The EMS operations manager said that paramedics use video technology to enable the doctors to get involved. “We check on patients, do a full evaluation and report back what we found.”

This kind of interaction goes a long way toward helping patients avoid the trauma of an ambulance ride to an emergency room.

“This population of patients unfortunately are used to going to the hospital on a somewhat regular basis,” Cimino said. “They’ve had a crew of people in an emergency situation pulling them out of bed, putting them on a stretcher with lights and sirens and everyone asking them questions.”

The House Calls paramedic program take a totally different approach, he said, allowing for more time to be spent with the patient, while a full evaluation is performed. Talking to patient’s one-on-one is valuable, Cimino said, and so is the feedback from the family.

Abrashkin said that the House Calls team find that 80 percent of the time the patient can stay at home using the community paramedic program. And the House Calls program also provides much-needed relief to the patient’s caretakers.

“Just as it can be traumatic for the patients, it can be traumatic for the family members that are usually looking after them,” said Cimino, “They’re sometimes more appreciative than the patients themselves. It takes a huge weight off their shoulders.”

Nearly 1,300 people are actively in the the Northwell Health House Calls program at any given time in Nassau and Suffolk counties as well as Queens. Of these participants, 83 live in Glen Cove and the surrounding communities.

Abrashkin said advertising hasn’t been necessary because referrals come from friends, families and hospitals. “It’s universally loved by patients, providers and paramedics,” she said.

Cimino said he believes programs like House Calls will become the norm going forward. “It’s an opportunity to bring the care to the patients instead of pulling them out of their comfortable environment where they are safe with family and caretakers,” she said. “It’s great from a patient care standpoint and great for hospital systems.”

Another advantage of the program, Abrashkin said, is that it is cheaper than the traditionally provided services. For her, the success of House Calls is personal.

“I wanted to do something that really had an impact and made a difference in people’s lives,” she said. “I’ve been extremely happy and it really is a great way to practice medicine. I really think it’s making an impact on our patients and their families.”

The proof lies with patients like Elizabeth Engle who turns 98 in June, “I don’t have to depend on anybody to take me to the doctor,” she said. “I like House Calls very much.”

For information on House Calls, call (516) 876-4100.