How home care connects patients’ real-life settings to their healing

Penn Medicine physical therapist Renee Jones, PT, DPT knows the importance of helping patients, especially seniors, with addressing real-world challenges within the context of where they’ll be facing them: mostly in their homes.

At-home care means helping patients live in their home by working within their environment, not a facsimile of it that is often very different than the real-life setting. “When you’re in the hospital and having therapy, they have mock stairs. They have a mock washing machine. But when you’re in someone’s home, you’re actually seeing what the challenges are, in real time,” she said.

Jones has exclusively provided in-home care for 12 years, primarily in geriatric care. Many of her patients are homebound, and she’s often helping them after they have been discharged from the hospital. A lower limb amputee herself due to a birth defect and then a car accident, she knows the importance of physical therapy and how it can help someone adapt to their world after a major physical change.

Sometimes Jones can suggest making changes to the home environment, something as simple as rearranging furniture, to make living in that space easier for a patient. “I can assess how their impairments and functional limitations affect their participation with their families and in the community right then and there,” she said.

She will also go over a patient’s medications and make sure that they are being taken appropriately. On one recent visit, Jones found out that a patient had expired medications mixed in with their current medications. That prompted a telehealth visit with the patient’s doctor. Jones has also had patients on oxygen swear that no one in the home smokes, only to find an ashtray in the living room.

Jones works in the same community where she lives in Southwest Philadelphia and knows she’s bringing Penn’s high level of care to patients who may not have the means and resources to travel back to a clinical care setting for physical, occupational, speech, or other kinds of therapy after a hospitalization.

“We get a view that no other clinician gets,” she said. “We see challenges, we see changes, we see declines, we see improvements. Since we’re in the home, we catch a lot of things.”

This on-the-ground perspective is one key way that home health care—a growing area of business for Penn Medicine, and a growing area of preference for patients—is transforming the way health care is delivered.

Community health workers—another important faction of Penn Medicine’s home care work force—are particularly attuned to helping patients deal with challenges in their daily lives that impact their health. The Penn Center for Community Health Workers, which now sits under the umbrella of Penn Medicine At Home, was initially established nearly a decade ago by Shreya Kangovi MD, MS, an internal medicine physician and researcher from Penn’s Perelman School of Medicine.

The center hires and trains non-medical professionals from the community to work long-term with patients to help them manage and prevent chronic disease and its complications. The program is one of the largest and most comprehensive in the field and a national model for promoting health equity, preventing hospitalizations, and reducing health care costs.

For individual patients, especially those from marginalized backgrounds or experiencing poverty, it’s a rare opportunity to build real trust with a person connected to the health care system.

As Ernest Gardner, a senior community health worker, described at the spring Health System town hall, sometimes it takes time to get a patient to feel comfortable opening the door to their home. Gardner gradually built trust with one such patient, who had been repeatedly admitted to the hospital for chronic obstructive pulmonary disease (COPD), especially in the summer months. “I visited his home in 90-degree weather,” Gardner recalled. “All he had was a box fan for ventilation and cooling, so that definitely contributed to his COPD exacerbation.” Gardner shared that information with the patient’s primary care practitioner—and ultimately she purchased an air conditioner for her patient.

More types of ‘home’ settings

Connecting with patients where they live means Penn Medicine is also caring for patients in settings that might not always be considered “home.”

After needs for support and preventing hospitalizations became clear during the COVID-19 pandemic, Penn Medicine has been forging stronger connections with nursing homes, initially in West Philadelphia. Penn Medicine At Home has since expanded its partnerships to 800 long-term care facilities across the region with grant funding from the state of Pennsylvania, working with facilities on quality improvement to improve care for residents and staff satisfaction.

For Valerie Simon of Southwest Philadelphia, returning home from the hospital after breaking her hip this summer was only the first step toward staying there. A retired grandmother with Parkinson’s disease, Simon has a particular destination in mind in her recovery: the corner store just a short distance away, so close it’s visible from her front porch. Before this most recent fall, if she needed an onion or a half dozen eggs, she could walk there using just a cane that she could carry down the stairs herself. Now, she relies on a walker that is too bulky to hold while gripping the stair railing, and she gets fatigued trying to cross the busy street before the light turns red.

If she were going to physical therapy appointments in a clinic, Simon would still do the same exercises for strength, endurance, and balance that Renee Jones does with her at home. But she wouldn’t get the real-world practice she does with her home-care physical therapist at her side.

On a recent crisp September morning, after leaning on her sturdy stone porch post for balance during her strength exercises, Simon navigated the uneven sidewalks with Jones at her side. Jones then helped her repeatedly practice stepping up at the curb’s edge in front of the store to ensure she knows how to avoid tripping. Along the way on the slow, careful walk, the two laughed and joked like old friends.

Editor’s note: This article originally appeared in the Fall/Winter 2022 issue of Penn Medicine magazine in a longer version. It has been edited into four separate parts, covering an overview of home care changes for patients, how the COVID-19 pandemic affected home care services, the business growth of home care in the health care industry, and the impact of providing care in patients’ real-world and community settings (above).