Peninsula Circle of Care coaches meet patients for “home visits” wherever they’re comfortable, even if that means at a cafe.
Many of our patients didn’t want home visits. They might have had issues with hoarding or were embarrassed that they couldn’t keep their home as tidy as before they got sick. They didn’t want to have to deal with that emotionally every time someone came to their home—so they would say they didn’t want home visits even though they needed the help and support.
Mills Peninsula is a non-profit hospital in Burlingame, CA that has partnered with the Palo Alto Medical Foundation and Peninsula Family Services to develop the Peninsula Circle of Care program. The hospital has 241 beds and serves a primarily elderly population (average age of 81) living alone with 90% on Medicare. Peninsula Circle of Care, their transitions program, began in 2012 and is influenced by the Care Transitions Program and a community based model.
What We Tried
We didn’t force people to do anything. It’s great for us to get into the home because we can see their environment and notice any potential barriers to their health, but if they aren’t ready for it, we start with follow up phone calls. Or, if they’re able to get out of the house, we meet them at cafes or even in the waiting room before their doctor’s appointment. It’s just about finding a time and place where we can talk about how things are going and coaching them to overcome any barriers they are facing.
Patients love knowing that they have this other option. It also helps to build trust. A lot of times we start with phone calls or meet at Starbucks and after awhile they may ask if we can meet in their home. It’s great when that happens. It means you’ve built that trust, and you’re now able to see where they spend most of their time and able to get more insight into what might be hindering their care at home.