Most dentists work only in their offices. But some make home visits, like Charles Doring, a dentist in Rockville, Maryland, who travels equipped with a portable cabinet on wheels that carries a portable X-ray machine, a compressor, a suction device and his headlamp.
Mobile dental units have been emerging across the country, many of them designed for older adults, including some serving assisted living centers and nursing homes. But they do not normally visit private homes.
Paul Glassman, a California professor of dentistry, came up with a different approach, called Virtual Dental Home.
It uses telehealth to connect dentists in their offices with dental hygienists who can visit patients in their homes, said Glassman, associate dean for Research and Community Engagement at California Northstate University School of Dental Medicine in Elk Grove.
Laws governing the role of hygienists vary from state to state, but in some states, including California, they can obtain special licenses that allow them to treat homebound patients with temporary fillings.
Medicare does not cover most dental care and procedures, including cleanings, fillings, extractions, and dentures. Some Medicare Advantage plans include treatments, so you should carefully review whether dental care is covered under your plan.
Miriam Godwin is Director of Health Policy for the National Kidney Foundation, based in New York City. Most US residents with irreversible kidney disease must travel to a dialysis center for treatment, Godwin wrote in an email.
“The United States has much lower rates of home dialysis – about 15% – than other developed nations, where home dialysis can approach 80%,” Godwin said. However, hoping to turn things around, the previous government set a goal of 80% of patients receiving home dialysis by 2025, he said.
The two main types of dialysis are peritoneal dialysis and home hemodialysis. Prescriptions — that is, the amount of dialysis received and the schedule — can be tailored to the patient’s schedules and preferences.
Who benefits the most? “Really, anyone who doesn’t want to make the trip to and from a center three times a week,” Godwin said. That can include people with families, those who care for other family members and those who work, he said, as well as students and frequent travelers.
Patients have been especially vulnerable to COVID-19, due to their underlying illnesses and because most of them had to rely on dialysis centers, where social distancing was difficult, Godwin said.
Medicare covers most of the costs of dialysis, but it does not cover the costs of staff who care for dialysis patients in their homes. Securing that reimbursement is a key goal of the National Kidney Foundation, Godwin said.
Collection of samples
Nathan Cron is president of a nonprofit company that collects blood, stool, urine, and sputum samples. His company, the Las Vegas-based National Phlebotomy Provider Network, connects patients with technicians who visit them at home to collect samples for analysis by independent laboratories.
“Since the beginning of the pandemic, interest in and utilization of our home sample collection services has increased significantly,” Cron wrote in an email.
Your company’s clients include Kaiser Permanente, residential care centers, and thousands of individual patients.
Other Key Advances in Home Care
X-rays: Portable X-ray machines have gained popularity and quality in recent years, allowing patients to stay at home instead of waiting in a busy emergency room. Medicare will pay for portable X-rays if certain conditions are met.
Intravenous treatment: This may be necessary when a patient comes home from a hospital stay where they received high doses of antibiotics, anti-nausea medications, or extra fluids. A nurse can go home to administer the medicine. Or a caregiver, a friend, or even the patient can learn to operate the IV set. Medicare will pay for home infusion set, supplies, nurse visits, training and follow-up for caregivers.
Chronic Disease Care Management: Medicare pays medical staff for the care management services they provide to patients who have two or more serious chronic conditions – for example, arthritis and diabetes – that are expected to last at least 12 months and whose care is expected to last that time. These services are classified as medical care in the Medicare fee-for-service program, so the patient is responsible for 20% of the cost (unless they purchase supplemental insurance to help cover the shortfall).
A doctor usually manages the patient’s care, listing their health problems and goals, and developing a comprehensive care plan. The doctor can coordinate with a home health agency to send caregivers to the home.
“It is very beneficial to ensure that the primary care physician, home health agency and other providers are aware of changes in the health status of patients, such as medication changes, recent falls , recent visits to emergency rooms or ongoing treatment for a chronic illness, “said Zach Gaumer, a Medicare policy expert based in Washington, DC
The National Association of Chronic Disease Directors, based in Decatur, Georgia, offers help to those with chronic diseases, and tips on how to measure blood pressure or how to Talk to your doctor about a cancer diagnosis.
Note: It is important that you check with your healthcare provider to make sure the treatments listed here are covered by your Medicare plan.
The American Academy of Home Care Medicine maintains an online guide to home care agencies in each state.