Like most of us, many people living with heart disease or a chronic heart condition don’t want to go to the hospital. Even though medical technology and advanced cardiac methodology, medications and therapies have resulted in more outpatient procedures and shorter inpatient stays, most patients would rather be home. Travel can be difficult and time consuming and the home is often safer from the risk of infection than a hospital. Importantly, home is where their minds are more at ease and their bodies are comfortable; home is where they are surrounded by caretakers and the people they love.
That patient-centered perspective is critical to Tufts Medicine Care at Home’s mission. “We want what the patient wants,” says Heidi Landers, RN, BSN, MHA, Vice President of Home Health Services for Tufts Medicine Care at Home. “Today we talk about treating heart failure as part of a comprehensive approach to care. It’s not just about diet and medication. It’s the holistic approach. We want to treat the whole person and provide an individualized care plan. We want to provide the right care at the right time in the right place. And for most people, that place is in their home.”
Home is also where the patient feels more empowered to take charge of their own well-being and healthcare journey. “Home and palliative care prepares the patient and their family, and empowers them to manage their disease moving forward,” says Bernice Burkarth, MD, HMDC, FAAHPM, chief medical officer of Tufts Medicine Care at Home. “They’re not being told what to do by a doctor or nurse. Instead, we help them understand their illness, their trajectory, and identify for themselves what their goals are. They learn what medicine they need to take when this happens or what doctor they need to call in this instance. They can layer on care and focus on their overall quality of life.”
There’s no place like home
There are many reasons a patient with heart problems might seek home healthcare. In some cases, mobility is an issue, and it can physically taxing to get in and out of the house. Going to the doctor is often stressful. Due to economic or infrastructure issues, transportation to and from the hospital might be difficult. In many cases, the patient, themselves, might be responsible for a child or another person who needs care. The Tufts Medicine home care team, spearheaded by its dedicated nurses, has all the resources necessary to transform a home into a sanctuary of state-of-the-art care — while maintaining the comforts of home. This goes beyond just bringing a cuff to check your blood pressure. They can monitor and treat hypertension, COPD, or chronic heart failure, perform blood work and any ostomy or physical therapy that might be necessary. They can also handle pain management. And home is the ideal place for education when it comes to diet, nutrition, physical rehabilitation and medication adherence.
That window into patients’ lives can also alert the care team to other, non-clinical needs that might be impacting the person’s health. They can help with personal care, such as getting dressed and bathed; meal preparation to keep them nourished; light housekeeping, such as laundry, dusting, or clean-up to ensure an environment conducive to wellbeing; caregiver relief for an overburdened loved one; or even medication reminders to make sure the patient stays on schedule. If there are needs, such as financial issues, that the care team can’t directly address, they can often connect the patient to social workers and other resources to bridge the gap. “It’s invaluable to see them in that home setting,” says Dr. Burkarth. “You get so much insight into what factors impact their ability to take in the information you give them, retain it, and implement it. You see the barriers in the home setting that aren’t obvious when they get dressed up to go to the hospital.”
Living in comfort and dignity
Chronic heart conditions, like congestive heart failure, are serious, complex and often terminal. In these cases, home care is about more than just comfort and convenience — it’s also about empowering the patient to live their lives with dignity. “Palliative care is not meant to go into the home and direct someone what to do with the rest of their life,” says Dr. Burkarth. “It’s meant to be a megaphone for the patient and help them arrive at what they want to happen. We want to help them understand their situation and make informed decisions when they’re not in crisis mode. Palliative care can look around and ask, in a way that isn’t threatening: ‘What resources can we bring to bear here?’”
Palliative care focuses on minimizing pain and discomfort and managing symptoms. But it also deals with emotional and spiritual support. Patients with chronic heart conditions experience good days and bad days, with many highs and lows. Tufts Medicine Care at Home is there to do more than just perform tests and administer treatments — these men and women are there to help manage anxiety, depression, and all the emotional distress that comes with these conditions. And they help remind patients that they are more than just their illness. “It’s a challenging disease to manage for anyone,” says Dr. Burkarth. “That’s where palliative care can help. We assist with the illness, fatigue, shortness of breath, and challenges with appetite. But we can also work on how you feel about what this could mean for the rest of your life. How do you want to live with this chronic illness and how can we communicate that to your family and care team?”
Communication is key, says Dr. Burkarth. Because rather than transition between home care and palliative care, it’s important to layer the two and incorporate the cardiac team, other specialists, and primary care physicians for a holistic and coordinated approach to a patient’s health and well-being. The idea is to keep patients out of the hospital, especially out of the emergency room, and home where they can be comfortable, relaxed, and healthy in body, mind and spirit. To help them live their best life. “I love home care with every beat of my heart,” says Landers. “That care is the best kind you can give. People want to be in their homes.”
