11383906 - a house with a stethoscope wrapped round it. concept for property maintenance or other real estate related.

All the movement towards home health even for emergency services makes me think of a giant game board. The usual get sick go to the hospital card is being replaced. It is daunting to read about how hospitals stays make  older patients sicker. Hospital admission happens for many important reasons but the consensus  seems to be building that you have a good chance of  going home weaker and with more difficulties . Between the risk of infections, the longer periods of immobility and adding more drugs that can lead to drug induced dementia, no wonder some older folks just refuse to go unless it is dire.

I  think I know why my mother years ago cautioned me to stay away from hospitals  as best you can. The issue of what is considered  observation and not is still being worked out for payment.  Those two or three days of figuring out how sick you are can cost you dearly in the pocketbook. One way or the other you feel like you are rolling the dice.

The hospital at home concept is starting to move or creep to the forefront of care, depending on your perspective.   You do not catch serious bacterial viral infections from being at home. Hopefully the attention you get is more hands on than the  barely there doctors making rounds and the overworked nurses.  ER treatment is already there for those with very definable  with specific progressive  disorders or diseases such as Parkinson’s or advanced congestive heat failure.  The seems more clearly a win win: http://www.nytimes.com/2016/11/08/health/older-patients-community-paramedics.html?&hpw&rref=health&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

Given the availability of paramedics and nurse practitioners, this could be a  very viable shift in care of the older population – more quality individualized care at home. But beyond this  parameter of certain progressive ailments, when the person’s health history is well known, where does the line get drawn?  When do we enter the danger zone of just enough care not the best care? Maybe home zone healthcare as I will call it, that is getting as much of your medical needs even x-rays lab tests done while at home, is a blissful solution.

Going really dark here, I have a genuine fear in the wake of our recent election that the social and medical safety net will be frayed or torched.  To illustrate the system already does not work all the time, I present some some findings on home health care fraud with Medicaid patients. It is very disturbing reading, and may cause you to throw objects against the wall: http://khn.org/news/seniors-suffer-amid-widespread-fraud-by-medicaid-caretakers/    

The real question, is the motivation to turn to more levels of health care done at home primarily for financial cost savings? Should we be able to  have a play it safe zone by deciding ourselves, who is the referee? It is the new game in town and we do not know exactly how it is going to turn out so vigilance and activism is important.