The Value of Home-Based Primary Care: Qualitative Exploration of Homebound Participant Perspectives

Abstract

Older adults’ preference to age in place and health systems’ commitment to cost-effective quality care has set the stage for a growing interest in home-based primary care (HBPC). The objective of this study was to explore what patients and caregivers value about HBPC and what modifications could improve its value. Semi-structured individual interviews ( n = 20) were audio-recorded, transcribed, and coded for themes. Four themes emerged: (a) HBPC offers peace of mind because patients can access care without leaving the home and can reach the primary care team at all hours, (b) HBPC supports aging in place by providing in-home care, (c) HBPC supports provider rapport building because of the intimate setting and continuity of care, (d) HBPC patients and caregivers have significant nonmedical needs. Findings suggest that teams developing or expanding on HBPC programs should prioritize access to providers, rapport building with patients and families, and supporting patients’ and caregivers’ nonmedical needs.

A Qualitative Study of the Social and Lived Experiences of Homebound Older Adults

“…They gained pride and self-respect from learning to perform ADLs and IADLs independently, such as doing laundry despite being wheelchair-bound. Home health service providers should teach willing homebound adults who desire increased autonomy to independently perform patient work such as personal care tasks as allowed by their current abilities (Johns Hopkins School of Nursing, 2021; LaFave et al, 2020). Some participants mentioned feeling a decreased sense of self-worth because they were unable to enrich others’ lives.…”

“…Medical appointments are likely one of the few social interactions that homebound older adults have—an assertion supported by our interview data (National Academies, 2020a). Homebound older adults in a recent qualitative study said it would be valuable if health care staff could help address their significant nonmedical needs (LaFave et al, 2020). Health care providers should assess and identify at-risk individuals, include social isolation in medical records, and connect patients with social work and community programs (Abedini et al, 2019; National Academies, 2020b).…”

“…Health care providers should assess and identify at-risk individuals, include social isolation in medical records, and connect patients with social work and community programs (Abedini et al, 2019; National Academies, 2020b). Home-based medical care (HBMC) could play a major role in improving the health and well-being of this population, as it supports aging in place and facilitates rapport between patients and providers (Cheng et al, 2020; LaFave et al, 2020; Mickler et al, 2021). Meal delivery services, used by more than a quarter of our research participants, can also reduce loneliness, increase independence, and encourage autonomy among homebound older adults (Abedini et al, 2019; Thomas et al, 2016).…”

A Home Repair and Modification Program Embedded Within Mount Sinai Visiting Doctors

“…Home-based primary care (HBPC) is one clinical model that directly engages with the homebound, in which interdisciplinary care teams provide comprehensive primary care in the home to individuals who have difficulty accessing primary care in the medical office setting (Ornstein et al, 2009; Reckrey et al, 2020). In one qualitative study, HBPC patients expressed that one primary reason why they value HBPC is because it enables them to remain in the community (LaFave et al, 2021). Many of the homebound patients cared for by HBPC providers have minimal social and financial resources and have substantial needs for interventions to improve their safety and independence at home (Foer et al, 2012; Reckrey et al, 2014).…”

A Home-Based Care Research Agenda by and for Homebound Older Adults and Caregivers

“…The care of homebound older adults and the delivery of home-based care (Harris-Kojetin et al, 2014) are attracting the interest and attention of the research community in the wake of studies demonstrating the benefits of home-and community-focused delivery models (LaFave et al, 2020). Such models include home-based primary care (HBPC; Stall et al, 2014;Totten et al, 2016), home-based palliative care (Cassel et al, 2016), Community Aging in Place Advancing Better Life for Elders (CAPABLE; Szanton et al, 2019), homedelivered meals (Morris et al, 2019), home-and communitybased services (Valluru et al, 2019), and others.…”