Dr. Nadia Marsh examines Fermin Berze, 76, in his home on the Lower East Side.
Cabrini Brings Doctoring Home
By Julie Jacobs
Of all the challenges Carmen Vasquez has faced in caring for her husband Rafael, an 85-year-old end-stage Alzheimer’s patient, one of the most difficult has been getting him to a doctor. Bedridden and nonverbal, Rafael has been homebound for the past six years, and Carmen has had to rely on an ambulette to transport him to his physician’s office. But all that changed this past September when Cabrini Medical Center on Manhattan’s East 19th Street launched its own “Visiting Doctors” program in parallel with an existing program at Mount Sinai Medical Center that only reached down to 50th Street. The innovation harks back to the bygone era in which doctors made house calls with their black bags in hand.
The Vasquezes were referred to the program by Rafael’s primary-care physician at Cabrini, and since then Rafael has received a physical, blood work, vaccinations, and other vital services in the comfort of his apartment.
“In the past it was very tough for me to take him to the doctor,” says Carmen. “Now I have less worry because I don’t have to arrange for transportation. I’m very happy with the program and grateful for the referral.”
Homebound Focus
According to the New York City Department of Aging’s 2000 data, 39.2 percent of individuals beyond the age of 65 and living within the five boroughs had mobility problems or self-care limitations. And as average life expectancy increases, this figure continues to climb.
“More and more people are finding it hard to take care of themselves and seek medical attention,” says José A. Cortes, M.D., Cabrini’s associate director of medicine and the clinical director of Cabrini Visiting Doctors. “They’re confined to apartments that they’ve lived in for more than 25 years, and are ultimately becoming homebound in what are known as ‘naturally occurring retirement communities.’ Usually they don’t even have access to primary care, so we look to break down barriers that prevent them from receiving medical treatment. Making house calls is the simplest way to describe what we do, but it’s really so much more.”
For more than a century, Cabrini has played an integral role in meeting the health-care needs of special populations, including the frail elderly who make up the vast majority of homebound city residents. Through the Visiting Doctors program, administered in collaboration with Mount Sinai Medical Center, Dr. Cortes and his team see homebound patients who reside from 59th Street to the Battery. Participating physicians provide hands-on, high-quality medical care to men and women with complex and advanced illnesses, seeking not only to prolong life, but to enhance quality of life. They give patients a sense of dignity and independence.
“What we offer is different from home care, although we do work with the Visiting Nurse Service,” Dr. Cortes points out. “We aim to deliver the full range of medical services along a continuum of primary, preventive, and palliative care.”
That range includes lab work, vaccinations, pain management, oxygenation, home assessments, EKGs, X-rays, medication prescriptions, referrals for physical therapy and assistive devices, and physical examinations. “I provide the same services that are offered in outpatient clinics or private doctors’ offices,” says Gisela Zapata, M.D., a visiting doctor who became familiar with the plight of homebound patients firsthand. “During my residency, I saw patients in the internal-medicine clinic. Many were unable to show up for their appointments. By participating in Cabrini’s program, I feel I can help patients who may be living alone and struggling with many social and health issues.”
Team Approach
Cabrini’s Visiting Doctors make make house calls on weekdays from 9 a.m. to 5 p.m. for both routine and urgent matters. They are available by phone 24/7. They meet with their Mount Sinai counterparts every Monday or Wednesday to present and discuss cases, with staff members from both hospitals sharing off-hour emergency coverage.
The doctors from Cabrini are trained at Mount Sinai to perform home-based evaluations. They specialize in internal medicine and/or geriatrics, and work closely with home-care, visiting nurse, community, and hospice agencies. And they speak Spanish.
“Our physicians are bilingual, which is a significant strength for Cabrini’s surrounding culturally rich neighborhoods,” Dr. Cortes says. “We have a talented, dedicated, multidisciplinary team of physicians and nurse practitioners, and a registered nurse. These professionals are trained not only to assess the needs of individual patients and to monitor treatment, but also to listen attentively and integrate patient and family preferences into the best approach possible.”
Not Just for the Elderly
While the program targets the frail elderly, many of whom are chronically or terminally ill with Alzheimer’s, cardiovascular disease, diabetes, cancer, and other debilitating conditions, patients of all ages can take advantage of Visiting Doctors, regardless of ability to pay. “We’re here for any person who is not able to go out and seek medical help,” says Dr. Cortes. “That may mean someone with paralysis who can’t walk and is bound to a wheelchair, or someone who has a psychiatric illness.”
Dr. Zapata attends to a varied patient base. She has one young patient who suffers from agoraphobia (fear of open spaces) but is otherwise healthy. Another patient, Jerry Olijnyk, 51, has coped with morbid obesity for the past five years. He lives alone, suffers bouts of congestive heart failure, and has developed other acute and chronic conditions.
“I’m very limited in terms of mobility and medical care, but I’m not considered an emergency,” Olijnyk says. “So although I need an ambulette to see a doctor, I can’t get one. Up until now I’ve had little support, and getting care has been a major problem for me.”
Olijnyk’s caseworker discovered Cabrini’s Visiting Doctors and referred Jerry to the program. He has since had several visits from Dr. Zapata, during which he had a blood workup, was vaccinated for flu, and much else.
“Dr. Zapata’s been great. She’s done the whole nine yards and followed up to see how I’m doing. I’m not a senior yet, but this experience has taught me a lot. These doctors are very welcome and I’m glad the program exists.”
Results to Date
Thus far, Dr. Zapata has made approximately 25 home visits and has found them highly gratifying and rewarding. “I saw one patient for the first time in September. Her living conditions were awful and she needed many services. We were able to help her. Today she looks much better and her quality of life is significantly improved.”
“Our patients have felt extremely well cared for, and our doctors have learned a great deal,” says Dr. Cortes. “It’s been humbling, interesting, and amazing to be able to assess people in their homes. You get a clearer picture of their needs, their issues, and their family’s involvement.”
Cabrini’s Visiting Doctor’s program continues to grow quickly, taking on upwards of 10 new patients every week. The hospital hopes eventually to expand to other boroughs, and to get more physicians on board.
For more information about Cabrini’s Visiting Doctors Program, call (212) 241-4003.
