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• About Kansas Home Visiting
• Why Support Is Important
• About MIECHV
• Find a Program
• Explore Resources
• Resources for Visitors
• What is MCH Home Visiting?
• Kansas Home Visiting Needs Assessment
• 2024 Kansas Home Visiting Conference

Steps for Conducting a Home Visit

Establishing Trust and Connection

Meeting the family on its home ground may contribute to their sense of control and active participation in planning and achieving health goals.

Phases/Activities of a Home Visit

Initiation Phase

• Identify source of referral for visit
• Clarify purpose for home visit
• Share information on reason and purpose of visit with family

Pre-Visit Phase

• Initiate contact with mother/family
• Establish shared perception of purpose with mother/family
• Determine mother/family’s willingness for home visit
• Schedule home visit
• Review referral and/or family record

In-Home Phase

• Introduction of self and identity
• Social interaction to establish rapport
• Establish relationship
• Implement educational materials and/or make referrals
• Review visit with family
• Plan for future visits as needed

Post-Visit Phase

• Record visit and plan for next visit
• Follow-up with educational materials and/or referrals

Preventive care starts here

Aetna® Healthy Home Visits gives you access to preventive care at no added cost — it’s already included in your plan.

Schedule your visit

How does a Healthy Home Visit benefit you?

You deserve even more ways to find and prevent health conditions than just your physical exam. That’s why your plan includes a yearly in-home health visit from a licensed clinician. They’ll help address your overall health needs. And, it’s all from the comfort of your home.

To get you preventive care in home, we work with the experienced team at Signify Health®. They’ll answer all your health questions. And share a visit summary with your doctor to keep them in the loop.

Hear from one member, Nancy* , about how a Healthy Home Visit found a blood flow issue — and alerted her doctor to get her the care she needed.

Transcript: Nancy Baton, Aetna Medicare Advantage Member

Hi, my name is Nancy Baton. I am a retired high school principal and middle school principal. And I am truly enjoying my retirement.

I live with my husband, and I’ve been married to Bill for, it’ll be 38 years this summer. We have two children, grown children, and I have 5 grandsons.

When it came time for me to enroll in Medicare, I wanted the one with the least amount of hassles. And I had been told what a great health plan Aetna has. That’s why I chose Aetna and I’m very happy I did.

Every year Aetna offers the opportunity for a Healthy Home Visit. The nice part about the HHV is I don’t go anywhere. The nurse comes here to me. So I’m comfortable in my own environment. I don’t have to leave the house. And It’s just nice to have somebody come to you for a change.

It was a registered nurse and she spent about an hour and a half. Goes over my medications. Checks my blood pressure. And then said to me she thought I have a problem with circulation. So she did a test on me and my doctor called me and said you need to see a vascular surgeon. And I’m under his care. Now I never would have caught something that could be potentially very dangerous had that nurse not come to my home.

Having the support of Aetna and not having to worry about bills or paperwork or is this covered. I didn’t have any of that. All I do now is concentrate on my recovery.

If you’re not healthy, you’re not going anywhere. So Aetna has helped me stay on track.

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This is a true member story and is not a paid endorsement.

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To learn more, go to AetnaMedicare.com/prevent  or contact Aetna® Member Services

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See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area

©2023 Aetna Inc.

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What should I expect from my visit?

Before your visit

Once you schedule your Healthy Home Visit through Signify Health, you’ll get a confirmation for your appointment. You’ll also get an email, text or call reminder 24 hours before your visit. If we don’t hear from you to set up your appointment, a member of the Signify Health team will reach out to help schedule your visit.

During your visit

On the day of your visit, a nurse will spend up to an hour with you in your home. They’ll answer health questions, address any concerns and more. This includes:

• Checking vital signs and reflexes
• Reviewing medical history
• Going over medications
• Checking breathing, eyes or feet
• Perform preventive screenings 

After your visit

A summary of the visit will be shared directly with you and your doctor. Should anything with immediate concern come up, we help coordinate the care you need.

Prefer a virtual visit? You can also schedule a telehealth appointment .  

Get your visit on the calendar

Schedule your visit online.

Select the date and time that works best for you with Signify Health’s secure, easy-to-use scheduler. (Have your ID card ready — your form will need to match exactly what’s on your insurance card.)

Speak with Signify Health directly

Sometimes, talking to a real person is easier. To schedule by phone, call 1-855-746-8709 ${tty} Monday – Friday, 9AM to 8PM ET. If we don’t hear from you, someone from the Signify Health team will reach out to help schedule your visit.  

Still have questions?

Learn more about what to expect from Signify Health.

Visit Signify Health for more info

Aetna and Signify Health are part of the CVS Health® family of companies.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. Other Physicians/Providers are available in our network. Participating health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.  

Call 1-855-746-8709 ${tty} Monday to Friday, 9 AM to 8 PM ET

*For Healthy Home Visit video

Nancy is a real member and her story is based on real experiences.

Also of interest:

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Resources For Living is not available for members with Aetna Part D (prescription only) plans, Dual Eligible Special Needs Plans (D-SNPs), Institutional Special Needs Plans (I-SNPs) or Medicare Supplement plans.

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House Call Doctor Visits Make Life Easier for Seniors and Caregivers

Important: This is an informational article to explain how house call doctor visits can benefit seniors. DailyCaring isn’t a medical organization, we aren’t medical professionals, and we aren’t affiliated with any healthcare organizations. We aren’t qualified to respond to any medical questions.

House call doctor visits benefit older adults and caregivers

Getting your older adult to the doctor’s office for an appointment can be difficult or sometimes impossible.

Whether they’re frail, can’t walk on their own, or have Alzheimer’s or dementia , getting out of the house is hard on both of you. Going to a doctor’s office can also expose seniors to germs or harsh weather.

We explain what a house call doctor is, what type of insurance they accept, how to find one, and what to look for in terms of services.

What is a house call doctor?

Today, many doctors are bringing back the old practice of visiting patients in their homes. With house calls, older adults don’t have to go through the stress and difficulty of getting to the doctor’s office. And neither do you.

Another bonus is that these doctors usually spend more time with patients. You won’t have to fit all your questions into a 15 minute visit.

Just remember that house calls aren’t for emergency situations (call 911 instead). They’re basically like a regular office visit.

Do they accept Medicare?

Yes, many house call doctors accept Medicare , private insurance, and sometimes Medicaid . It usually costs the same as a regular office visit.

But every house call doctor is different, so make sure you understand their fees and accepted insurance plans before making an appointment.

How to find a house call doctor

Some large health care systems like Kaiser Permanente or the VA have programs that include home visits by doctors and nurses. For example, Kaiser’s home-based palliative care program includes house calls.

Even your older adult isn’t part of a large health network, it’s worthwhile to ask your older adult’s doctor if they have home doctor visit programs.

The American Academy of Home Care Medicine’s provider directory is another way to locate a house call doctor in your area.

You can also use Google to search for “house call doctor” + your city or county or “home doctor visit” + your city or county (don’t include the quotation marks).

What to look for in a house call doctor

Before booking an appointment, make sure you understand the doctor’s services, fees, and billing.

Questions to ask:

• Do you specialize in treating seniors, people with Alzheimer’s or dementia , or those with  multiple chronic conditions ?
• Do you accept Medicare , Medicaid , or my older adult’s private insurance plan?
• If we want, can we also keep my older adult’s primary care doctor?
• Will you communicate with my older adult’s existing doctors and specialists so their care is coordinated?

Examples of house call doctor private practices

We want to be clear that we’re not recommending any specific home doctor services or companies and aren’t affiliated with any of these businesses. These are examples to give you an idea of what a house call doctor looks like and the type of services that are typically offered.

Examples of what a house call doctor looks like:

• Visiting Physicians Association (VPA)
• Bay Area House Call Physicians
• Kindred House Calls

Recommended for you:

• 4 Expert Tips for Managing Multiple Chronic Health Conditions in Seniors
• 7 Tips for Helping Seniors at the Doctor: Being a Health Advocate
• Should Seniors See a Geriatrician?

By DailyCaring Editorial Team Image: Now It Counts

This article wasn’t sponsored and doesn’t contain affiliate links. For more information, see How We Make Money .

• Share Article on:

Related Articles

Flu Shot for Seniors: 5 Reasons Why It’s So Important

9 Top Questions About Palliative Care vs. Hospice Care

8 Things to Have the Doctor Check After an Aging Person Falls

3 Ways to Improve Senior Dental Care to Reduce Heart Disease and Alzheimer’s Risk

18 comments, tony carrancho.

My parent s lives in [redacted for privacy]. How do i get started locating a house call doctor. I am pretty sure there insurance covers this. Thank you. TONY

DailyCaring

We hope the tips and suggestions in the article above will help you find a house call doctor in your parents’ local area.

Susan Quercio

My 95 year old father has a deep cough and he is disoriented. Temp 99 degrees.

Please contact your father’s doctor immediately or the local hospital to find out how to safely get him examined by a doctor (to reduce risk of exposure to Covid-19).

DailyCaring isn’t a medical organization, we aren’t medical professionals, and we aren’t affiliated with any healthcare organizations.

Ruby m VanNostern

I live in [redacted for privacy] and need a doctor visit in home.

This article includes suggestions for how you can find house call doctor services in your area. At DailyCaring, we aren’t doctors and don’t provide any medical services. We hope you’re able to find a great house call doctor in your area.

Stewart Goldman

need Doctor for a home visit Andrews N.C.

Joseph Artusa

I need a doctor

Linda Williams

I was released from the hospital on Thursday after 5 days.I am not able to go to Dr office but most definitely need to be checked.Still having breaking problems and am very week.I have severe asthma and blood pressure was running very high from so much steroids.Could I possibly get help.Thanks so much.

I’m so sorry to hear that you’re not feeling well. Since you’re noticing some issues with your recovery, it’s essential to call your primary doctor immediately. Since they’re the ones who have been treating you and are familiar with your recent hospitalization, they’re the best people to advise you on what you need. If you need help getting to your doctor’s office, you may want to contact your local Area Agency on Aging or a ride sharing service. Or, use the tips in this article to search for a doctor in your area who makes house calls.

Here are some articles that may be helpful: — 8 Ridesharing Services for Seniors https://dailycaring.com/8-ridesharing-services-for-seniors/ — 6 Affordable Senior Transportation Options https://dailycaring.com/6-affordable-senior-transportation-options/ — Local Community Resources for Seniors and Caregivers: Area Agency on Aging (to connect you with local organizations that may be able to help) https://dailycaring.com/local-community-resources-for-seniors-and-caregivers-area-agency-on-aging/ — 4 Ways to Know If Seniors Need to Return to the Hospital https://dailycaring.com/4-ways-to-know-if-seniors-need-to-return-to-the-hospital/

(DailyCaring doesn’t provide any services and isn’t affiliated with any medical providers.)

What areas do you service?

This article explains that house call doctor services are available and could help senior and caregivers. We also share suggestions for finding one in your area, but we do not provide any services ourselves. I hope you’re able to find a great local house call doctor!

What areas do you service

This article includes suggestions for finding house call doctor services in your area. We at DailyCaring aren’t doctors and don’t provide any medical services. I hope you’re able to find a great house call doctor in your area.

need a home care doctor

I hope the information above helps you find a great home care doctor in your area.

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What is a Home Visit Checklist, and How To Make One? A Comprehensive Guide

• Ossian Muscad
• May 29, 2023

Last Updated on May 29, 2023 by Ossian Muscad

Home visits are an essential part of providing quality patient care. They can be a great way to monitor safety, identify potential problems, and assess patients’ overall well-being in their homes. However, it is essential that all home visits occur with proper planning and preparation to ensure the best possible outcome for both the healthcare provider and the patient.

One tool that can help achieve this goal is a home visit checklist. This article will look at a home visit checklist and how to create one to provide your patients with safe and effective care during every visit.

What is a Home Visit in the Medical Field?

A home visit in the medical field, also known as a house call, is when a healthcare professional, such as a doctor, nurse, or therapist, visits a patient’s residence to provide medical care, assessment, or treatment. Home visits are often utilized for patients who have difficulty accessing healthcare facilities due to mobility issues, chronic illnesses, or other limitations. These visits enable healthcare providers to assess patients’ living conditions, offer personalized care, and monitor their progress in a comfortable and familiar environment.

Why Are Home Visits Important?

House calls are essential for several reasons, as they benefit patients and healthcare providers. Some of these benefits include:

• Improved Access to Care: House calls help patients with difficulty traveling to healthcare facilities due to mobility issues, chronic illnesses, or lack of transportation. This ensures that they receive timely medical attention and care.
• Personalized Care: Home visits allow healthcare providers to understand patients’ living conditions better and tailor their care accordingly. This personalized approach can lead to more effective treatment plans and improved patient outcomes.
• Continuity of Care: House calls enable healthcare providers to monitor a patient’s progress and adjust treatment plans as needed. This continuous care can help prevent complications, reduce hospital readmissions, and improve overall health.
• Patient Comfort: Receiving medical care in the familiar surroundings of one’s home can be less stressful and more comfortable for patients, particularly those with anxiety or cognitive impairments.
• Cost-effective Care: Home visits can reduce healthcare costs by preventing unnecessary hospitalizations and emergency room visits. They also enable more efficient use of healthcare resources, as providers can see multiple patients during one visit.
• Enhanced Patient-provider Relationship: House calls foster stronger relationships between patients and healthcare providers, allowing for more personal interactions and increased trust. This can lead to better communication, greater satisfaction, and improved adherence to treatment plans.

House calls are crucial in providing accessible, personalized, and cost-effective healthcare services, particularly for vulnerable populations and those with limited access to traditional medical facilities.

Different Types of Home Visits

House calls can be categorized into different types based on the purpose and patient needs. These variations are meant to address different issues and provide more specialized care. With that said, here are four common types of home visits:

Illness Home Visits

These visits focus on patients experiencing acute or chronic illnesses requiring medical attention and care. Healthcare providers assess the patient’s condition, perform necessary examinations, and provide treatment or medication adjustments. They also offer guidance on managing symptoms and may recommend additional services or referrals if necessary.

Dying Patient Home Visits

In cases where patients are nearing the end of their lives, healthcare providers visit to offer palliative care and support. The goal is to ensure patients’ comfort and dignity during their final days while addressing pain, symptoms, or emotional concerns. Providers may also assist with advance care planning and coordinate with hospice services if required.

Assessment Home Visits

These visits primarily evaluate a patient’s overall health, living conditions, and support system. Healthcare providers assess the patient’s physical, mental, and social well-being, identifying potential risks or issues that need addressing. This type of visit is essential for elderly patients, individuals with disabilities, or those with complex medical needs.

Hospitalization Follow-up Home Visits

Following a hospital discharge, healthcare providers may conduct home visits to ensure a smooth transition back to the patient’s home environment. They assess the patient’s recovery progress, monitor for any complications or signs of relapse, and provide guidance on self-care and medication management. Follow-up visits also help identify any additional services or resources the patient may need to aid in their recovery.

Each home visit serves a specific purpose and is essential in providing comprehensive and personalized care for patients in their homes.

What is a Home Visit Checklist?

A home visit checklist is a comprehensive list of items, tasks, and assessments that healthcare professionals use to guide during a medical house call or home visit. It helps ensure that all necessary patient care aspects are addressed and nothing is overlooked. 

What Items To Include in a Home Visit Checklist?

The specific components of a home visit checklist may vary depending on the healthcare provider’s specialty and the patient’s individual needs. However, some common elements often included in a home visit checklist are:

• [ ] Patient Identification: Confirm the patient’s identity, address, and contact information.
• [ ] Medical History Review: Review the patient’s medical history, including current medications, allergies, past surgeries, and any ongoing health issues.
• [ ] Vital Signs Assessment: Check the patient’s vital signs, such as blood pressure, heart rate, respiratory rate, and temperature.
• [ ] Physical Examination: Perform a thorough physical examination based on the patient’s presenting complaints and medical history.
• [ ] Living Conditions Assessment: Evaluate the patient’s home environment for safety, cleanliness, and any potential hazards that could affect their health.
• [ ] Medication Management: Assess the patient’s medication regimen, including proper storage, dosage, and adherence to prescribed treatments.
• [ ] Functional Status Evaluation: Determine the patient’s ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs), such as mobility, personal hygiene, meal preparation, and managing finances.
• [ ] Mental Health Assessment: Screen for signs of depression, anxiety, cognitive decline, or other mental health concerns.
• [ ] Social Support Evaluation: Assess the patient’s social support network, including family, friends, and community resources.
• [ ] Care Plan Development: Collaborate with the patient and their caregivers to develop a personalized care plan, addressing any identified issues and setting realistic goals for improvement.
• [ ] Documentation: Record all findings, assessments, and interventions during the home visit, ensuring accurate and up-to-date patient records.
• [ ] Follow-up Arrangements: Schedule any necessary follow-up appointments or referrals to specialists and give the patient clear instructions on the next steps.

A well-structured home visit checklist ensures that healthcare professionals provide comprehensive and consistent care, addressing all aspects of a patient’s health and well-being during each visit.

Create Home Visit Checklists Using a Low-code Platform

If you’re a healthcare provider looking for an efficient way to create home visit checklists, consider using a low-code platform such as DATAMYTE. With drag-and-drop capabilities and easy customization options, you can quickly build custom checklists tailored to your patient’s needs.

DATAMYTE is a quality management platform with low-code capabilities. The DataMyte Digital Clipboard , in particular, is a low-code workflow automation software that features a checklist and smart form builder. This tool lets you create a comprehensive home visit checklist that you can use and share with your team.

To create a checklist or form template using DATAMYTE, follow these steps:

• Log in to the DATAMYTE software and navigate to the ‘Checklist’ module.
• Click “Create Checklist.”
• Add a title to your checklist; select the category where it belongs.
• Start adding items to the checklist by clicking “Add Item.” 
• Define the description of each item, what type of answer it requires, and other relevant specifications (e.g., reference documents, acceptance criteria, limits).
• Assign a team member responsible for conducting the inspection using the checklist.
• Add signature fields for approvals (e.g., supervisors, quality assurance personnel).
• Save the checklist—you can now access it anywhere, and it will be available on any device.

DATAMYTE also lets you conduct layered process audits, a high-frequency evaluation of critical process steps, focusing on areas with the highest failure risk or non-compliance. Conducting LPA with DATAMYTE lets you effectively identify and correct potential defects before they become major quality issues.

With DATAMYTE , you have an all-in-one solution for creating and implementing home visit checklists. Book a demo now to learn how DATAMYTE can help you streamline the home visit process and ensure quality patient care.

Today’s medical industry is as diverse and complex as ever, with different types of patients requiring different levels of care. Home visits are an essential part of providing high-quality patient care, and having a comprehensive home visit checklist is essential for healthcare professionals to ensure that every aspect of an individual’s health and well-being is addressed during each visit. By leveraging low-code tools such as DATAMYTE, healthcare providers can easily create and use custom checklists that meet their patient’s needs. Get started today!

Related Articles:

• What is a Smog Inspection Checklist, and How To Make One? A Comprehensive Guide
• What is a Security Patrol Inspection Checklist, and How To Make One? A Comprehensive Guide

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House Calls – We Bring the Doctor’s Office to the Patient

At Mobile Physician Services, we provide comprehensive care to improve the health and quality of life of our patients – in the convenience and comfort of their own home. Our team of board-certified doctors, advance nurse practitioners, and physician assistants specialize in providing care for patients with medically complex and chronic conditions.

Our Services

We accept Medicare, many insurance plans, and self-pay.

To find out more about our services:

Call Toll-free: (855) 232-0644

E-mail us at [email protected]

Primary Care

Pain management, palliative care.

At Mobile Physician Services, our customized care teams provide patients with both comfort and familiarity as they work with a dedicated primary care provider and care coordinator to improve their health. Our physicians and staff take a proactive approach to preventive care, chronic disease management, and chronic illness support right where you live.

Each home visit includes an in-depth examination and individualized treatment plan, which is monitored and adjusted through routine follow-up visits. The primary care provider will deliver your ongoing care and will recommend to you specialty services as needed.

• Annual Wellness visits : This wellness visit allows your primary care provider to create or update your personalized prevention plan. This visit includes a review of your medical and social history related to your health and may include counseling about preventive services. This plan may help you to prevent or reduce the chances of future illness based on your current health and risk factors.
• New Illness Exams : When a new symptom or ailment arises, call us. Early indications of not feeling well could be a clue that you may be getting sick. A symptom in one part of the body may also be a sign of a problem in another part of the body. Moreover, unrelated symptoms that might seem minor on their own, could be warning signs of a more serious medical disease or condition. The new illness exam can be very brief or more detailed depending on your concerns and the provider’s findings.
• Follow-up Care: Involves a regular medical checkup, which may include a physical exam and laboratory testing. Follow-up care checks are a proactive way of assessing the potential for and preventing health problems from returning after treatment of a disease has ended or an illness has seemingly passed.
• Referral for Specialty Care : Referrals are the link between primary and specialty care. The referral coordination includes the documentation of patient care activities, the transfer of information, the inter-provider communication itself, and the integration of care services to the patient. Mobile Physician Services is a multi-specialty practice so many of these specialty referral services can be made seamlessly with little inconvenience or disruption to the patient and caregivers regular routines.
• Medication Management: Medication management is a treatment structure that ensures our patients are receiving optimal therapeutic results from their prescription medications, both in the short and long term. Our team’s goal is to mitigate medication noncompliance and monitor all prescriptions treatments so that drug interactions complement one another for the most optimal outcome for our patients.

The provider may be a physician, advanced practice nurse or a physician assistant. A dedicated care coordinator will also be assigned for each patient to help arrange comprehensive services and assist patients and their caregivers.

• Online Patient Portal: You and your designated caregiver, if you choose, will be able to connect with your provider through a convenient, safe and secure environment which allows access to your health records and a way to communicate with our staff in a timely manner.
• Telephone Assistance : On call providers are available 24/7 weekdays and weekends.

Our psychiatry team specializes in the diagnosis and management of mental, emotional and behavioral disorders. They carefully evaluate each patient to develop an individualized treatment plan to improve the patient’s overall mental and physical well-being.

• Depression : Depression is a common and often serious medical illness that negatively affects how you may feel, the way you may think, and how you may act. Depression can cause feelings of sadness, despair and hopelessness, which may lead to a loss of interest in activities you once enjoyed.
• Anxiety : Intense, excessive, and persistent worry and fear about everyday common situations. The worry or anxiety could make you feel fatigued, irritable, and interfere with your regular sleep habits.
• Dementia : An overall term that is used to describes a collection of symptoms related to an individual’s decline in memory or other thinking skills. It may be severe enough to diminish a person’s ability to perform everyday common activities. The effects of dementia can negatively influence your memory, thinking and social abilities.
• Phobias : A phobia is when you experience excessive panicking or an irrational fear reaction to a situation. If you have a phobia, you may experience a deep sense of dread or fright when you encounter the source of your fear. The fear may be a certain place, situation, object, animal or even another person.
• Behavioral disorders : Attention deficit, hyperactivity, bipolar, learning, defiant or conduct disorders are all examples of complaints that may have a detrimental impact on a person’s interpersonal relationships with family, friends, and co-workers.

Our team can provide behavioral counselling and medical therapy, when appropriate, to help a patient feel better about themselves and to assist them with better coping and managing their condition.

Our wound care specialists have been trained in the attention and treatment of all types of acute and chronic wounds. They have skill and experience in wound debridement and wound care procedures – managing chronic, non-healing wounds and infections, with a demonstrated care that fosters healing… right in the patient’s own home.

We specialize in serving homebound patients who may also be bed-bound or have difficulty in walking or moving around. As a result, immobility compression sores develop at pressure points on the body when the weight of an immobilized individual rests continuously on a firm surface, such as a mattress or wheel chair. Often these same patients are on oxygen or have high-risk medical conditions which makes it an even more challenging and stressful effort for them to travel to a doctor’s office for an appointment. Thus, the necessity for in home care and treatment.

Wounds that benefit from specialized wound care techniques include:

• Diabetic foot wounds and ulcers
• Post-surgical wounds
• Traumatic wounds caused by injury
• Arterial and vein stasis caused by lack of circulation
• Immobility pressure sores. (Bed sores from stillness)

We work closely with home health agencies to provide ongoing care and monitoring of patient’s wounds.

Our board-certified podiatrists treat foot pain, wounds, and more. Treatments may include but are not limited to treating conditions of the lower extremities which could hinder mobility.

• We will review each patients’ medical history to evaluate the condition of the feet, ankle or lower leg
• Carry out a diagnosis on the feet and lower legs through examination and medical tests
• Order physical therapy when deemed necessary
• Treat wounds of the lower extremities using various wound care modalities. This may include debridement to improve the healing potential
• Promote prevention, health & well being, the treatment and management of the foot and related problems, disability, deformity, and the pedal complications of chronic diseases for the elderly
• Prescribe and fit prosthetic appliances such as diabetic shoe inserts and evaluate for bracing if necessary
• Refer patients to other specialists for treatment, including conditions such as diabetes or arthritis
• Advise patients on ways to prevent future leg problems and increase speed of recovery
• Monitor the recovery progress of patients to determine the need for change in treatment

We know it’s not always easy to leave home to get the care you need for your eyes. Our optometrists bring state-of-the-art diagnostic eye equipment and technology to your home – making it much easier for you to get the vision care you need.

During a visit, your doctor will exam each eye for signs of serious issues such as glaucoma, cataracts, macular degeneration, and detached retinas, among other conditions.

Receiving regular eye exams regardless of the state of your vision can help detect serious eye problems at their earliest stages ─ when they are most treatable. During an eye exam, your doctor will observe and evaluate the health and condition of the blood vessels in your retina, which can be good indicators of the health of your blood vessels throughout the rest of your body.

• Comprehensive eye exams : This exam goes beyond a simple vision screening. A comprehensive eye exam includes a host of tests in order to do a complete evaluation of the health of your eyes and your vision.
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• Refractions: This test is given as part of your routine eye examination. It is often referred to as a vision test. This test assists your eye doctor in measuring you for the exact lens prescription you will need.
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A pain management specialist is a provider with advanced training in diagnosing and treating pain. Our pain management specialists treat pain stemming from a variety of different causes, whether it’s neuropathic pain or headache, or the result of injury, a surgical procedure, cancer or another illness.

Palliative care is an approach to the holistic care of patients, including family and caregivers, to improve the quality of their lives after the diagnosis of a chronic debilitating disease or life-limiting illness that may cause a host of complaints.

Palliative care can begin at diagnosis and continue to be offered while the patient is continuing active treatment through different phases of their life limiting condition. Palliative care is for any patient with a chronic illness who is experiencing a decreased quality of life because of symptoms related to their illness or treatment, like renal dialysis, oxygen therapy or chemotherapy. The care is provided by a specially-trained team of doctors, nurse practitioners, physician assistants, and other specialists who work together to provide an extra layer of support to the patient and their caregivers.

Palliative care can help in symptom control including not only pain, but nausea, weakness, shortness of breath, fatigue and weight loss at any time during their diseases, not only at the end of life.

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Brief Home Visiting: Improving Outcomes for Children

What is Home Visiting?

Home visiting is a prevention strategy used to support pregnant moms and new parents to promote infant and child health, foster educational development and school readiness, and help prevent child abuse and neglect. Across the country, high-quality home visiting programs offer vital support to parents as they deal with the challenges of raising babies and young children. Participation in these programs is voluntary and families may choose to opt out whenever they want. Home visitors may be trained nurses, social workers or child development specialists. Their visits focus on linking pregnant women with prenatal care, promoting strong parent-child attachment, and coaching parents on learning activities that foster their child’s development and supporting parents’ role as their child’s first and most important teacher. Home visitors also conduct regular screenings to help parents identify possible health and developmental issues.

Legislators can play an important role in establishing effective home visiting policy in their states through legislation that can ensure that the state is investing in evidence-based home visiting models that demonstrate effectiveness, ensure accountability and address quality improvement measures. State legislation can also address home visiting as a critical component in states’ comprehensive early childhood systems.

What Does the Research Say?

Decades of research in neurobiology underscores the importance of children’s early experiences in laying the foundation for their growing brains. The quality of these early experiences shape brain development which impacts future social, cognitive and emotional competence. This research points to the value of parenting during a child’s early years. High-quality home visiting programs can improve outcomes for children and families, particularly those that face added challenges such as teen or single parenthood, maternal depression and lack of social and financial supports.

Rigorous evaluation of high-quality home visiting programs has also shown positive impact on reducing incidences of child abuse and neglect, improvement in birth outcomes such as decreased pre-term births and low-birthweight babies, improved school readiness for children and increased high school graduation rates for mothers participating in the program. Cost-benefit analyses show that high quality home visiting programs offer returns on investment ranging from $1.75 to $5.70 for every dollar spent due to reduced costs of child protection, K-12 special education and grade retention, and criminal justice expenses.

Maternal, Infant and Early Childhood Home Visiting Grant Program

The federal home visiting initiative, the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, started in 2010 as a provision within the Affordable Care Act, provides states with substantial resources for home visiting. The law appropriated $1.5 billion in funding over the first five years (from FYs 2010-2014) of the program, with continued funding extensions through 2016. In FY 2016, forty-nine states and the District of Columbia, four territories and five non-profit organizations were awarded $344 million. The MIECHV program was reauthorized under the Medicare Access and CHIP Reauthorization Act through September 30, 2017 with appropriations of $400 million for each of the 2016 and 2017 fiscal years. The Bipartisan Budget Act of 2018 ( P.L. 115-123 ) included new MIECHV funding. MIECH was reauthorized for five years at $400 million and includes a new financing model for states. The new model authorizes states to use up to 25% of their grant funds to enter into public-private partnerships called pay-for-success agreements. This financing model requires states to pay only if the private partner delivers improved outcomes. The bill also requires improved state-federal data exchange standards and statewide needs assessments. MIECHV is up for reauthorization, set to expire on Sept. 30, 2022.  

The MIECHV program emphasizes that 75% of the federal funding must go to evidence-based home visiting models, meaning that funding must go to programs that have been verified as having a strong research basis. To date,  19 models  have met this standard. Twenty-five percent of funds can be used to implement and rigorously evaluate models considered to be promising or innovative approaches. These evaluations will add to the research base for effective home visiting programs. In addition, the MIECVH program includes a strong accountability component requiring states to achieve identified benchmarks and outcomes. States must show improvement in the following areas: maternal and newborn health, childhood injury or maltreatment and reduced emergency room visits, school readiness and achievement, crime or domestic violence, and coordination with community resources and support. Programs are being measured and evaluated at the state and federal levels to ensure that the program is being implemented and operated effectively and is achieving desired outcomes.

With the passage of the MIECHV program governors designated state agencies to receive and administer the federal home visiting funds. These designated  state leads provide a useful entry point for legislators who want to engage their state’s home visiting programs.

Advancing State Policy

Evidence-based home visiting can achieve positive outcomes for children and families while creating long-term savings for states.

With the enactment of the MIECHV grant program, state legislatures have played a key role by financing programs and advancing legislation that helps coordinate the variety of state home visiting programs as well as strengthening the quality and accountability of those programs.

During the 2019 and 2021 sessions, Oregon ( SB 526 ) and New Jersey ( SB 690 ), respectively, enacted legislation to implement and maintain a voluntary statewide program to provide universal newborn nurse home visiting services to all families within the state to support healthy child development. strengthen families and provide parenting skills.    

During the 2018 legislative session New Hampshire passed  SB 592  that authorized the use of Temporary Assistance to Needy Families (TANF) funds to expand home visiting and child care services through family resource centers. Requires the development of evidence-based parental assistance programs aimed at reducing child maltreatment and improving parent-child interactions.

In 2016 Rhode Island lawmakers passed the Rhode Island Home Visiting Act ( HB 7034 ) that requires the Department of Health to coordinate the system of early childhood home visiting services; implement a statewide home visiting system that uses evidence-based models proven to improve child and family outcomes; and implement a system to identify and refer families before the child is born or as early after the birth of a child as possible.

In 2013 Texas lawmakers passed the Voluntary Home Visiting Program ( SB 426 ) for pregnant women and families with children under age 6. The bill also established the definitions of and funding for evidence-based and promising programs (75% and 25%, respectively).

Arkansas lawmakers passed  SB 491  (2013) that required the state to implement statewide, voluntary home visiting services to promote prenatal care and healthy births; to use at least 90% of funding toward evidence-based and promising practice models; and to develop protocols for sharing and reporting program data and a uniform contract for providers.

View a list of significant  enacted home visiting legislation from 2008-2021 . You can also visit NCSL’s early care and education database which contains introduced and enacted home visiting legislation for all fifty states and the District of Columbia. State officials face difficult decisions about how to use limited funding to support vulnerable children and families.

Key Questions to Consider

State officials face difficult decisions about how to use limited funding to support vulnerable children and families and how to ensure programs achieve desired results. Evidence-based home visiting programs have the potential to achieve important short- and long-term outcomes.

Several key policy areas are particularly appropriate for legislative consideration:

• Goal-Setting: What are they key outcomes a state seeks to achieve with its home visiting programs? Examples include improving maternal and child health, increasing school readiness and/or reducing child abuse and neglect.
• Evidence-based Home Visiting: Have funded programs demonstrated that they delivered high-quality services and measureable results? Does the state have the capacity to collect data and measure program outcomes? Is the system capable of linking data systems across public health, human services, and education to measure and track short and long-term outcomes?
• Accountability: Do home visiting programs report data on outcomes for families who participate in their programs? Do state and program officials use data to improve the quality and impact of services?
• Effective Governance and Coordination: Do state officials coordinate all their home visiting programs as well as connect them with other early childhood efforts such as preschool, child care, health and mental health?
• Sustainability:  Shifts in federal funding make it likely that states will have to maintain programs with state funding. Does the state have the capacity to maintain the program? Does the state have the information necessary to make difficult funding decisions to make sure limited resources are spent in the most effective way? 

Related Resources

Where is federal early childhood policy heading.

In recent years, the federal government has played a more active role in early childhood care and education through pandemic-era relief funding and new regulations for the Child Care and Development Block Grant and Head Start programs. This article provides an in-depth view of trends in federal policy.

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The Practice of Home Visiting by Community Health Nurses as a Primary Healthcare Intervention in a Low-Income Rural Setting: A Descriptive Cross-Sectional Study in the Adaklu District of the Volta Region, Ghana

Kennedy diema konlan.

1 Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana

2 College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea

Nathaniel Kossi Vivor

Isaac gegefe, imoro a. abdul-rasheed, bertha esinam kornyo, isaac peter kwao, associated data.

The data used to support the findings of this study are included within the article.

Home visit is an integral component of Ghana's PHC delivery system. It is preventive and promotes health practice where health professionals render care to clients in their own environment and provide appropriate healthcare needs and social support services. This study describes the home visit practices in a rural district in the Volta Region of Ghana. Methodology . This descriptive cross-sectional study used 375 households and 11 community health nurses in the Adaklu district. Multistage sampling techniques were used to select 10 communities and study respondents using probability sampling methods. A pretested self-designed questionnaire and an interview guide for household members and community health nurses, respectively, were used for data collection. Quantitative data collected were coded, cleaned, and analysed using Statistical Package for Social Sciences into descriptive statistics, while qualitative data were analysed using the NVivo software. Thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion.

Home visit is a routine responsibility of all CHNs. The factors that influence home visiting were community members' education and attitude, supervision challenges, lack of incentives and lack of basic logistics, uncooperative attitude, community inaccessibility, financial constraint, and limited number of staff. Household members (62.3%) indicated that health workers did not adequately attend to minor ailments as 78% benefited from the service and wished more activities could be added to the home visiting package (24.5%).

There should be tailored training of CHNs on home visits skills so that they could expand the scope of services that can be provided. Also, community-based health workers such as community health volunteers, traditional birth attendants, and community clinic attendants can also be trained to identify and address health problems in the homes.

1. Introduction

Home visit practice is a healthcare service rendered by trained health professionals who visit clients in their own home to assess the home, environment, and family condition in order to provide appropriate healthcare needs and social support services. The home environment is where health is made and can be maintained to enhance or endanger the health of the family because individuals and groups are at risk of exposure to health hazards [ 1 , 2 ]. At home visit, conducted in a familiar environment, the client feels free and relaxed and is able to take part in the activity that the health professional performs [ 1 ]. It is possible to assess the client's situation and give household-specific health education on sanitation, personal hygiene, aged, and child care. The important role the health professional plays during home visits (HV) cannot be overemphasized, and this led Ghana to adopt HV as a cardinal component of its preventive healthcare delivery system. This role is largely conducted by community health nurses (CHN) [ 2 ]. Health education given during HVs is more effective, resulting in behavioural change than those given through other sources such as the mass media [ 3 ].

In the home, the health professionals, mostly CHN monitor the growth, development, and immunization status of children less than 5 years and carry out immunization for defaulters. Care is given to special groups such as the elderly, discharged tuberculosis, and leprosy patients as well as malnourished children [ 1 , 2 ]. It is also possible to carry out contact tracing during HVs [ 2 ]. These services may prevent, delay, or be a substitute for temporary or long-term institutional care [ 4 , 5 ]. HV has potential for bringing health workers into contact with individuals and groups in the community who are at risk for diseases and who make ineffective or little use of preventive health services [ 2 ]. Several factors influence the conduct of HVs. These factors include location of practice, general practitioners age, training status, and the number of older patients on the list and predicts home visiting rate [ 6 ].

The concept of HV has remained in Ghana over the decades, and yet, its very essence is imperative [ 3 ]. In Ghana, home visiting is one of the major activities of CHN. The health visitors, as CHNs were then called, went from house to house, giving education on sanitation and personal hygiene [ 3 ]. These nurses attempt to promote positive health and prevent occurrence of diseases by increasing people's understanding of healthy ways of living and their knowledge of health hazards [ 7 ]. HVs remain fundamental to the successful prevention of deaths associated with women and children under five; yet, there still remain certain gaps in the successful implementation of this innovative intervention in Ghana [ 4 ]. In Sekyere West district in Ashanti Region of Ghana, although nurses had knowledge of home visiting and had a positive opinion of the practice, they could not perform their home visiting tasks or functions up to standard [ 8 ]. Home visiting practice in that district among nurses was found to be very low, even though community members desired more [ 8 ]. The findings indicate that there is a need for HV [ 9 ]. Also identified were several health hazards, such as uncovered refuse containers, open fires, misplaced sharp objects, open defecation, and other unhygienic practices that a proper home visiting regiment can address [ 8 ]. At the service level, lack of publicity about the service, the cost of the service, failure to provide services that meet clients' felt needs, rigid eligibility criteria, inaccessible locations, lack of public transport, limited hours of operation, inflexible appointment systems, lack of affordable child care, poor coordination between services, and not having an outreach capacity were identified as the challenges associated with this kind of service [ 9 – 13 ].

Home visiting is a crucial tool for enhancing family healthcare and the health of every community. Ghana Health Service through home visiting services has supported essential community health actions and address gaps in knowledge and community practices such as reproductive behaviour, nutritional support for pregnant women and young children, recognition of illness, home management of sick children, disease prevention, and care seeking behaviours [ 4 ]. As many interventions are implemented by stakeholders in health to ensure that home visiting practices actually benefit community members, recent studies have not delved into the practices of home visiting in poor rural communities especially in the Volta Region of Ghana. This study assessed the home visiting practices in the Adaklu district (AD) of the Volta Region.

This study assessed the practice of home visiting as a primary healthcare (PHC) intervention in a poor rural district in the Volta Region of Ghana.

2. Methodology

2.1. study design.

This mixed method study employed a descriptive cross-sectional study design as the study involved a one-time interaction with the CHNs and the community members to assess the practice of HVs.

2.2. Study Setting

The AD is one of the districts in the Volta Region of Ghana and has about 40 communities. The district capital and administrative centre is Adaklu Waya. The estimated population of the district was 36391 representing 1.7% of the Volta Region's population before the Oti Region was carved out [ 14 ]. The district is described as a rural district [ 14 ] as no locality has a population above 5000 people. The economically active population (aged 15 and above) represents 67% of the population [ 14 ]. The economically inactive population is in full-time education (55.1%), performed household duties (20.6%), or disabled or too sick to work (4.6%), while the employed population engages in skilled agricultural, forestry, and fishery workers (63.1%), service and sales (12.6%), craft and related trade (14.6%), and 3.4% other professional duties [ 14 ]. The private, informal sector is the largest employer in the district, employing 93.9% [ 14 ]. There are 15 health facilities in the district government health centres [ 4 ], one health centre by Christian Health Association of Ghana, and 10 community health-based planning services (CHPS) of which 5 are functional [ 15 ]. The housing stock is 5629 representing 1.4% of the total number of houses in the Volta Region. The average number of persons per house was 6.5 [ 14 ], and the houses are mostly built with mud bricks [ 15 ]. The most common method of solid waste disposal by households is public dumping in the open space (47.5%). Some households dump solid waste indiscriminately (17.3%), while other households dispose of burning (13.3%) [ 14 ].

2.3. Study Population, Sample, and Sampling Technique

There are about 36391 inhabitants with 6089 households in AD [ 14 ]. This study mainly involved adult members of the household and CHNs from randomly sampled communities in the district. These sampled communities included Abuadi, Anfoe, Ahunda, Dawanu, Goefe, Helekpe, Hlihave, Tsrefe, Waya, and Wumenu. An adult member of the household is a person above the age of 18 years who has the capacity to represent the household. CHN [ 11 ] from the selected communities in the district was recruited. A CHN is a certified health practitioner who combines prevention and promotion health practices, works within the community to improve the overall health of the area, and has a role to play in home visiting.

Estimating for a tolerable error of 5%, with a confidence interval of 95%, and a study population of 6089 households, with a margin of error of 0.05 using Yamane's formula for calculating sample for finite populations, a sample of 375 households were computed. The sample size was increased to 390 to take into consideration the possible effect of nonresponse from participants. Multistage sampling technique was adopted to eventually select study participants. Each community was stratified into four geographical locations: north, south, east, and west with respondents being selected from every second house using a systematic sampling approach. In each household, an adult member of the household responded to the questionnaire.

A whole population sampling method was used to select eleven [ 11 ] CHNs from the specific communities [ 10 ] where the study took place in the district. The CHN that served the 10 selected communities were selected. The numbers selected from each community were Helekpe (18.2%), Waya (18.2%), Anfoe (9.1%), Tsrefe (27.3%) and Wumenu (27.3%). This represented 42.3% of the total CHN community of the district at the time of the study.

2.4. Pretesting

The questionnaire and interview guide were piloted using 30 adult household members and 5 CHNs, respectively, at Klefe CHPS in the Ho municipality. The data collected through the questionnaire were subjected to a reliability test on SPSS (version 22). The pretesting ascertained the respondent's general reaction and particularly, interest in answering the questionnaire. The questionnaire was modified until it produced a Cronbach alpha coefficient of 0.790. It can therefore be concluded that the questionnaire had a high reliability in measuring the objectives of the study. The pretesting helped in identifying ambiguous questions and revising them appropriately. It also helped to structure and estimate the time the respondents used to answer the questionnaires and to respond to the interview.

2.5. Data Collection

Researchers from the University of Health and Allied Sciences School of Nursing and Midwifery were involved in data collection. Five researchers received two days training in data collection, the study tools, and research ethics for social sciences prior to the commencement of data collection. All researchers had a minimum of a bachelor degree in CHN with at least three years' data collection experience.

Respondents were assisted to respond to a questionnaire within their homes. The household questionnaire had four [ 4 ] sections comprising personal details and how HV practice is carried out in the home such as frequency of visit, duration, and activities. Subsequent sections had respondents answer questions on the challenges, benefits, and factors that could promote the HV practice. It took an average of about 15 minutes to complete a single questionnaire.

A semistructured interview guide was used to interview CHNs. This guide was in four sections; the first section was personal details with subsequent sections on practice of home visits, constraints to the practice, the benefits, and promotion factors to HVs. An interview section lasted 20–25 minutes to complete.

2.6. Data Analysis

2.6.1. quantitative data.

Each individual questionnaire was checked for completeness and appropriateness of responses before it was entered into Microsoft Excel, cleaned, and transferred to the Statistical Package for Social Sciences (version 22) for analysis. The data were basically analysed into descriptive statistics of proportions. There were also measures of central tendencies for continuous variables.

2.6.2. Qualitative Data

In data analysis, thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion [ 16 ]. CHNs views were summarised based on the conclusions driven and collated as frequencies and proportions. Guest, Macqueen, and Namey summarised the process of thematic analysis as construing through textual data, identifying data themes, coding the themes, and then interpreting the structure and content of the themes [ 17 ]. In using this scheme, a codebook was first established, discussed, and accepted by the authors. The nodes were then created within NVivo software using the codebook. Line-by-line coding of the various transcripts was performed as either free or tree nodes. Double coding of each transcript was carried out by two of the researchers. Coding comparison query was used to compare the coding, and a kappa coefficient (the measurement of intercoder reliability) was generated to compare the coding that was conducted by the two authors. The matrix coding query was performed to compare the coding against the nodes and attributes using NVivo software that made it possible for the researchers to compare and contrast within-group and between-group responses.

2.7. Ethical Consideration

Ethical clearance was obtained on the 19th September, 2018, from the Research and Scientific Ethics Committee of the Institute of Health Research, University of Health and Allied Sciences (UHAS-REC A.2 [13] 18-19). Permission was sought from the district health authorities, chiefs, and assembly members of each study community. Preliminary to the administration of the questionnaires, an informed consent was obtained as respondents signed/thumb printed a consent form before they were enrolled into the study. Participants could withdraw from the study anytime they wished to do so.

3.1. Household Members' Views regarding Home Visit

The household representatives surveyed (375) had a mean age of 41.24 ± 16.88 years. The majority (26.5%) of household members were aged between 30 and 39 years. Most (75.1%) were females. The majority (97.1%) of people in households were Christians, while 38% was farmers. The majority (69.9%) of household members were married as 47.2% had schooled only up to the JHS level as at the time of this survey as given in Table 1 .

Demographic characteristics of household members.

The majority (73.3%) of adult household members had ever been visited by a health worker for the purpose of conducting HVs as a significant number (26.7%) of household members had never been visited by health workers in the community. Most (52.6%) household members had had their last visit from a health worker during the past month. Within the past three months, some (48.2%) community members were visited only once by a health worker. The majority (93.4%) of community members were usually visited between the time periods of 9am and 2pm as given in Table 2 . The community members contend that home visiting was beneficial to the disease prevention process (65%). The people that need to be visited by CHNs include children under five (25%), malnourished children's homes (14%), children with disabilities (14%), mentally ill people (11%), healthcare service defaulters (22%), people with chronic diseases (9%), and every member of the community (5%).

Practice of home visits in AD (household members).

Most (87.9%) community members were given health education during HVs conducted by the CHN. In describing the nature of health education that is most frequently given by CHNs during HVs, household members indicated fever management (14%), malaria prevention (20%), waste disposal (11%), prevention and management of diarrhoea (22%), nutrition and exclusive breastfeeding (14%), hospital attendance (14%), and prevention of worm infestations (5%). The majority (62.3%) of community members did not receive a minor ailment management during HVs as most (66.5%) of community members received vaccination during HVs by CHNs. Describing the type of minor ailment treatment given during the HV include care of home accidents (13%), management of minor pains (22%), management of fever (45%), and management of diarrhoea (20%). Household members (24.5%) did identify bad timing as a barrier for home visiting, while some (13.1%) did identify the attitude of health workers as a barrier to home visiting. However, most (67.3%) of the household members attributed their dislike for home visiting to the duration of the visit. The majority (95.2%) of household members indicated health workers were friendly. Some household members (78%) indicated they benefited from HVs conducted in their homes. The majority (91.4%) of household members showed that time for home visiting was convenient. Indicating if household members will wish for the conduct of the HV to be a continuous activity of CHNs in their community, the respondents (82%) were affirmative.

3.2. CHNs Views on Home Visit in AD

The mean age of CHNs was 30.44 ± 4.03 years as some (33.3%) were aged 32 years as the modal age. The CHNs (90.9%) were females with the majority (81.8%) being Christians as given in Table 3 .

Demographic characteristics of CHN.

In assessing the home visiting practices of CHNs, the researchers had some thematic areas. These thematic areas that were discussed include but not limited to the concept of HV by CHN, factors that influence the conduct of HVs, ability to visit all homes within CHN catchment area, reasons for conducting or not able to conduct HV, frequency of conducting home visits by CHN, and activities undertaken during HVs. This view that was expressed was simply summarised based on the thematic areas and presented in Table 4 as descriptive statistics related to the CHN conduct of HVs.

Summary of CHNs home visit practice in AD.

3.2.1. Concept of Home Visit by CHN

CHNs have varied descriptions of the concept of HV as it is conducted within the district. The description of HV was basically related to the nature and objective that is associated with the concept. The central concept expressed by participants included a health worker visiting a home in their place of abode or workplace, providing service to the family during this visit, and this service is aimed at preventing disease, promoting health, and maintaining a positive health outcome. These views were summarised when they said

“HVs are a service that we (CHNs) rendered to the client and his family in their own home environment to promote their health and prevent diseases. The central idea is that during the HV, the CHN is able to engage the family in education and services that eventually ensure that diseases are prevented and health is promoted.”

“HV is the art when the CHNs visit community members' homes to provide some basic curative and largely preventive healthcare services to clients within their own homes or workplaces. During this visit, the CHN helps the entire family to live a healthy life and give special attention or care to the vulnerable members of the society.”

“It is the processes when at-risk populations are identified; then, the CHN provides services to this cadre within their own home environment and sometimes workplaces as the case may be. Essentially, the CHN assists the family to adopt positive behaviours that will ensure they live with the vulnerable person in a more comfortable way.”

3.2.2. Factors that Influence the Conduct of Home Visits

The CHNs enumerated a cluster of factors that influence the conduct of HVs within the district. These factors ranged from community members education, attitude, supervision challenges, lack of incentives, and lack of basic logistics to conduct HVs. The uncooperative attitude of community members was identified by CHNs (36.4%) as a barrier to HVs. As they indicate, some community members did not support the continued visit to their homes or did not give them the necessary attention needed for the provision of services.

“Some community members do not understand the importance of HVs in the prevention of disease and for that matter are less receptive to the conduct of HVs. They just do not see the need for the service provider to come to their homes to provide services.”

“The client is the master of his own home; when you get into a home for a HV, the owner should be willing to talk or attend to you. Sometimes, you get into a home and even if you are not offered a seat, or you are just told we are busy, come next time. You know community service is not a paid job, so because the community members do not directly pay for the services we provide, essentially less premium is placed on the activities we conduct.”

“There is some resistance to HVs by some community members. Sometimes, you come to a house and can feel that you are not wanted; meanwhile, the home is part of the home that needs and has to get a HV because of the special needs they have. This is particularly specific in homes that believe that the particular problem is a result of supernatural causes.”

3.2.3. The Ability to Visit All Homes within CHN Catchment Area

The conduct of HVs is a basic responsibility for all CHNs as they remain as an integral part of the PHC delivery system in Ghana. Based on the nature and problems in the community, CHNs strategizes various means that will aid them to provide this essential service efficiently. CHNs (81.8%) are able to visit all homes in the catchment areas during a quarter. Some of the responses included the following:

“We do organise HVs, this is part of our routine schedule. As a community health nurse, to enjoy your work, you will need to organise HVs from time to time.”

“As for the HV, it depends on the strategies a particular CHPS compound is using. Irrespective of the community that one works in, you can always provide full and adequate care and service to the community if you plan well. First, you have to identify the “at need people” then the distance to their homes and put this in your short-term strategic plan for execution.”

“HVs are basic responsibilities of community health nurses, and we ought to execute it. In spite of the challenges, we cannot let those particularly hinder on our ability to conduct our very core mandate.”

Some CHNs were not able to visit all homes in their catchment areas, citing “hard to reach areas” and “Inadequate equipment” as the reasons for not being able to visit all households.

“Sometimes it is the distance to the clients' homes that makes it impossible to visit them. There are some homes if you actually intend to visit them, then you must be willing to spend the whole day doing only that activity.”

“Some clients' problems are such that you will need to have special tools before you visit them. For example, what use will it be to a diabetic client if you visit him/her and you are unable to monitor the blood sugar level or to a hypertension patient, you are not able to check the blood pressure because you do not have the required equipment?”

“To have a successful HV practice, I think the authorities should be willing to provide the basic logistics that will aid us to work. Without this basic logistics, we cannot.”

3.2.4. The Reasons for Conducting or Not Able to Conduct Home Visits

CHNs (72.7%) carried out both routine and special HVs. For those community health nurses who were not able to conduct HVs, several reasons were ascribed. Some of the reasons described included the lack of basic amenities to conduct HVs. The majority (18.2%) of CHNs also did attribute inaccessible geographical areas as a barrier to HV. Also, CHNs (63.6%) identified inadequate logistics and financial constraints as barriers to HV. All of the CHNs report on their activities regarding home visiting to the district health authorities.

“We basically lack the simple logistics that will assist us to conduct HVs. We do not have simple movable equipment like weight scales, thermometers, sphygmomanometers, and stethoscopes.”

“We do not have functionally equipped home visiting bags, so even if we decide to visit the homes, how much help will we be to the client?”

The other reasons included large catchment areas and lack of reliable transportation for the conduct of HVs in the AD.

“The catchment area is quite wide and practically impossible to visit every home. Looking from here to the end of our catchment area is more than 5 kilometers, without a means of transport, one cannot be able to visit all those homes.”

“I remember in those days; community health nurses were given serviceable motor cycles to aid in their movement and especially the conduct of HVs. Today, since our motorbike broke down 5 years ago, it has since not been serviced, yet we are expected to conduct HVs.”

“To conduct home visits, whose money will be used for transportation? The meagre salary I earn? Or the families or beneficiaries of the service have to pay?”

“The number of staff here is woefully inadequate, we are only two people here, how can we do home visiting and who will be left in the facility to conduct the other activities. For this reason, we are not able to conduct HVs.”

CHNs tried to visit the homes at various times depending on the occupation of the significant other of the homes, so that they can provide services in the presence of the significant others. CHNs (63.6%) visit 6–10 homes in a week as 90.9% CHNs conduct HVs in the morning. The reasons given for conducting some HVs in the evenings included the following:

“This place is largely a farming community, most people visit their farms during the mornings, so if you visit the home in the morning, you may not meet the significant others of the vulnerable person to conduct health education.”

“We do HVs because of the clients, so anytime it is possible, we will meet them at home, we conduct the visits at that time. For me, even if the case is that I can only meet the important people regarding the client at night, I visited them at that time. For community health nursing work, it is a 24-hour work and we must be found doing it at all time.”

3.2.5. Frequency of Conducting Home Visits by CHN

Various schedule periods were used based on health facilities for the purpose of HVs. Most (45.5%) conducted HVs three times in a week. CHNs (90.9%) had conducted HVs the week preceding the interview. Indicating that the last time HV was conducted, CHNs conducted a HV at least within the last week:

“HV is a weekly schedule in this facility; for every week, we have a specific person who is assigned to do HV just as all other activities that are conducted in this facility”.

“Yes, last week, we had a number of HVs; we made one routine HV and the other was a scheduled HV from a destitute elderly woman who was accused as a witch by some of her family members.”

Indicating if they sometimes get fatigued for conducting HVs weekly because of the limited number of staff, a community health nurse indicated that,

“I think it is about the plan we have put in place. There are about four people in this facility. We plan our activities that we all conduct HVs. In a month, one may only have one or two HVs, so it is unlikely that you will be fatigued in conducting HVs.”

“Yes, sometimes, it is really tedious, but we cannot let that be a setback. We have a responsibility to execute and we must be doing so to the best of our ability.”

3.2.6. Activities Undertaken during Home Visits

CHNs conducted health education (90.9%), management of minor ailments (54.6%), and vaccination/contact tracing (63.6%) during HVs. Describing if they are able to conduct the management of small ailments and home accidents at home, CHNs were divided in their ability to do this. Those were not able to do so indicated,

“…. And who will pay? Since the introduction of the national health insurance, we are not able to provide management of minor ailments during HVs. In those days, we were supplied with the medicines to use from the district, so we could provide such free services. But with the insurance now in place, we do not get medicine from the district, so whose medicine will you use to conduct such treatment?”

“I think our major goal is on preventive care. We have a lot to do with preventing diseases. Let us leave disease treatment to the clinical people. When we get ailments, we refer them to the next level of care to use their health insurance to access service.”

Identification of cases, defaulter tracing, and health education were identified as benefits and promotion factors of HVs. Identification of cases and defaulter tracing were both mentioned by CHNs as benefits and promotion factors of HVs.

“I think HVs should be continued and encouraged to be able to achieve universal, sustainable PHC coverage for all. Not only do we visit the homes, we also identify vaccination defaulters, tuberculosis treatment defaulters, and prevention of domestic violence against women and children and health education on specific diseases and sometimes we do immunisation.”

“In the home, we have a varied responsibility, treatment of minor ailments, immunization and vaccination, contact tracing, education on prevention of home accidents, etc.” It will be a disservice, therefore, if anyone tries to downplay the importance of HVs in our PHC dispensation.”

“Through HVs, we have provided very essential services that cannot be quantified mathematically, but the community members know the role of the services in their everyday lives. Even the presence of the community health nurse in the home is a factor that promotes girl child education and leads to woman empowerment.”

4. Discussion

This study assessed the home visiting practices in the AD of the Volta Region of Ghana. The concept of home visiting has been enshrined in Ghana's health history and executed by the CHN or public health nurses (PHN). In AD, only CHNs among all the various cadres of health professionals conducted HVs. This was contrary to the practice in the past when both CHN and PHN conducted HVs [ 18 ]. Notwithstanding the limited numbers of CHNs in the district, the majority of households (73.3 %) have a history of visits from a CHN. Home visiting is central in preventive healthcare services, especially among the vulnerable population. In children under five years, it is plausible that nurse home visiting could lead to fewer acute care visits and hospitalization by providing early recognition of and effective intervention for problems such as jaundice, feeding difficulties, and skin and cord care in the home setting [ 19 ]. Home visiting emphasizes prevention, education, and collaboration as core pillars for promoting child, parent, and family well-being [ 20 ].

In Ghana, under the PHC initiative, communities are zoned or subdivided and have a CHN to manage each zone by conducting HVs, including a cluster of responsibilities mainly in the preventive care sectors [ 4 ]. As rightly identified, HV is one of the core mandates of the CHN. Most of the community members who had received more than one visit in a week lived close to the health facilities indicating that there are homes which have never been visited, and CHNs are not able to cover all homes in their catchment areas. Factors that deter the conduct of HVs by CHN ranged from community members' level of education, attitude, supervision challenges, lack of incentives, and lack of basic logistics to conduct HVs. It is imperative that CHNs HVs especially those with newborn children to assess the home environment and provide appropriate care interventions and education as it was reported that 2.8% of 2641 newborns who did not receive a HV were readmitted to the hospital in the first 10 days of life with jaundice and/or dehydration compared with 0.6% of 326 who did receive a HV [ 21 ]. CHNs need to be provided with the right tools including means of transport to reach “hard to reach” communities and homes to provide services.

In rural Ghana such as the AD, community members leave the home to their places of work or farms during the morning sessions and only return home in the evening or late afternoon. HVs (93.4%) were conducted between 9am and 2pm, while some homes (6.6%) were visited between 3pm and 6pm. One problem faced by this timing difference is further expressed when CHNs indicated that they did not meet people at home during HVs. It is important for CHNs to be wary of their safety in client's homes as they show enthusiasm to visit homes at any time, and they could meet significant others. Therefore, to ensure safety, it is important to cooperate with clients and their families [ 22 ] in providing these services especially outside the conventional working hours. The need to use alternative timing of visits is essential as it is known that client participation is required to determine the scope of quality and safety improvement work; in reality, it is difficult for them to participate [ 23 ]. Also, some respondents indicated the time spent during HVs was too short (32.7%), and others (24.5%) wished the CHNs could spend more time with them. Community members have problems they wished could be addressed by the CHNs during HVs, but because of the number of households compared to the limited number of CHNs available, the CHNs could not spend much time during HVs and the respondents were not satisfied with the services rendered. It is likely that services will be better implemented by households if the CHN spends much time with the household and together implements thought health activities. Amonoo-Lartson and De Vries reported that community clinic attendants who spent more time in consultation performed better [ 24 ].

CHNs (8.2%) indicated they could not visit all households that needed the home visiting services in their catchment areas. Home visiting nurses are required to be mindful of the time and environment where they are performing care [ 22 ], so that they can allow for maximum benefit to the community. This notwithstanding, some community members (26.7 %) were not available during the HVs. The determination of suitable time between the CHN and the client is critical in ensuring that a positive relationship is established for their mutual benefit. The interval associated with HVs varied from one community or a health centre to another, and this was planned based on the specific needs of each community or CHPS catchment zone. There is actually no one-size-fits-all approach to home visiting [ 20 ] as several strategies can be adopted in providing services. The number of weeks or months elapsing between the visits ranged from one week to four months. The ministry of Health Ghana per the PHC system encourages CHN to conduct at least one contact tracing and/or HV session within a week within their communities [ 25 ]. All CHNs indicated that in their catchment area, they conducted at least one HV in a week and sometimes even more depending on the exigencies of the time.

Various activities are expected to be conducted by CHNs during HVs. These activities include the provision of basic healthcare services such as prevention of diseases and accidents, disease surveillance, tracing of contacts of infectious disease, tracing of treatment defaulters such as tuberculosis, diabetes mellitus, and hypertension and management of minor ailments at home. Community members (62.3%) did not receive a minor ailment management during HVs. CHNs are expected to be equipped with requisite knowledge, tools, and skills to be able to conduct these services in the homes. Also, the level of care that can be identified as a minor ailment as per the guidelines of the Ministry of Health needs to be specific as community members had varied classification of minor ailments and the level of care to be provided. Home visitors have varying levels of formal education and come from a variety of educational backgrounds marked by different theoretical traditions and content knowledge [ 20 ]. Other jurisdiction HV nurses drew blood for bilirubin checks and set up home phototherapy if indicated; they provided breastfeeding promotion and teaching on feeding techniques and skin and cord care [ 19 ]. Also, CHNs are expected to be able to provide baby friendly home-based nursing care services during a visit to the clients' home. HV nurses should also discuss the schedule of well-baby visits and immunizations [ 19 ] with families.

Important challenges associated with the conduct of HVs were identified as a large catchment area, lack of basic logistics, lack of the reliable transportation system, uncooperative community members, inadequate staff, and “hard to reach” homes due to geographical inaccessibility. Health education, management of minor ailment, and vaccination or contact tracing were the activities carried out in the homes. Home visiting nurses are under pressure to complete a job within an allotted time frame, as determined by the contract or terms of employment [ 22 ]. Time pressure significantly contributes to fatigue and depersonalization, and adjustments to interpersonal relationships with nurse administrators can have notable alleviating effects in relation to burnout caused by time pressure [ 26 ]. CHNs (63.6%) identified inadequate equipment and financial constraints as challenges to HV. Given evidence suggesting that relationship-based practices are the core of successful home visiting [ 27 – 29 ], with a natural harmony between the home visitor and the community members to the home, she renders her services [ 20 ]. A report published by the National Academy of Sciences (1999) also identified staffing, family involvement, language barrier, and cultural diversities as some of the barriers to a HV [ 30 ].

Health education (87.9%) dominated the home visiting activities. Health education helps to provide a safe and supportive environment and also build a strong relationship that leads to long lasting benefits to the entire family [ 5 ]. Face to face teaching in the privacy of the home is an excellent environment for imparting health information [ 31 ]. The CHNs stated that health education, tracing of defaulters, and identification of new cases are the benefits and promotion factors for conducting HVs. This implies that there are other critical aspects of HV that CHNs neglect such as prevention of home accidents and ensuring a safe home environment and care for the aged. Early detection of potential health concerns and developmental delays, prevention of child abuse, and neglect are also other benefits and promotive factors of HV. HV helps to increase parents' knowledge, parent-child interactions, and involvement [ 5 ]. The conduct of HV was not reported among all community members as some community members (22.0%) in the AD indicated their homes have never been visited. This is, however, an improvement over the rate of HVs that was reported in the Assin district in Ghana [ 32 ]. In the Assin district, about 84% of the respondents said they gained benefits from HVs [ 32 ]. In this study, respondents who were visited indicated the CHNs just inspected their weighing card while giving them no feedback. CHNs should implement various interventions to ensure that community members directly benefit from health interventions that are implemented during HVs to reduce the consequences that are usually associated with poor access to healthcare services especially in poor rural communities such as the AD.

5. Conclusion

The activities carried out in the homes were mainly centred on health education, contact tracing, and vaccination. Health workers faced many challenges such as geographical inaccessibility, financial constraints, and insufficient equipment and medications to treat minor ailments. If HV is carried out properly and as often as expected, one would expect the absence of home accidents, child abuse, among others in the homes, and a reduction in hospital admissions.

The need for strengthening HV as a tool for improving household health and addressing home-based management of minor ailment in the district cannot be over emphasized. It is important to forge better intersectoral collaboration at the district level. The District Assembly could assist the District Health Management Team with transport to support HVs. In addition, community-based health workers such as community health volunteers, traditional birth attendants, and community clinic attendants should also be trained to identify and address health problems in the homes to complement that which is already conducted by healthcare professionals.

Acknowledgments

The authors wish to express their profound gratitude to the staff and district health management team of the AD of the Volta Region of Ghana for providing them with the necessary support and assisting in diverse ways to make this study possible. They thank their participants for the frank responses.

Abbreviations

Data availability, conflicts of interest.

The authors declare that they have no conflicts of interest.

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What Makes Home Visiting an Effective Option?

Meeting in a family's home gives home visitors an opportunity to know families intimately. This sets the stage for close, trusting relationships — a critical element in any program designed to support children and their families.

By engaging in a warm, open relationship with parents, home visitors support a strong and secure relationship between the parent and child. Home visitors help parents become more sensitive and responsive to their child. The secure relationship between young children and their families creates the foundation for the development of a healthy brain. The home environment also allows home visitors to support the family in creating rich learning opportunities that build on the family's everyday routines. Home visitors support the family's efforts to provide a safe and healthy environment. Home visitors customize each visit, providing culturally and linguistically responsive services.

The home visiting model allows home visitors to provide services to families with at least one parent or guardian at home with the child or children. Families may choose this option because they want support both for their parenting and for their child's learning and development at home. For example, home visitors are available to families who live in rural communities and who otherwise would not be able to receive services. Home visitors bring services to families whose life circumstances might prevent them from participating in more structured settings or families challenged by transportation. Some programs can be flexible and offer services during nontraditional hours to families who work or go to school.

Every parent and home visitor bring his or her own beliefs, values, and assumptions about child rearing to their interactions with children. Home visiting can provide opportunities to integrate those beliefs and values into the work the home visitor and family do together.

In addition to establishing the relationship with each family during weekly home visits, home visitors provide opportunities to bring all families together twice a month. These group socializations reduce isolation, allow for shared experiences, and connect families to other staff in the program.

Resource Type: Article

National Centers: Early Childhood Development, Teaching and Learning

Program Option: Home-Based Option

Age Group: Infants and Toddlers

Last Updated: September 27, 2023

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BRIAN K. UNWIN, MAJ, MC, USA, AND ANTHONY F. JERANT, M.D.

Am Fam Physician. 1999;60(5):1481-1488

See editorial on page 1337 .

With the advent of effective home health programs, an increasing proportion of medical care is being delivered in patients' homes. Since the time before World War II, direct physician involvement in home health care has been minimal. However, patient preferences and key changes in the health care system are now creating an increased need for physician-conducted home visits. To conduct home visits effectively, physicians must acquire fundamental and well-defined attitudes, knowledge and skills in addition to an inexpensive set of portable equipment. “INHOMESSS” (standing for: i mmobility, n utrition, h ousing, o thers, m edication, e xamination, s afety, s pirituality, s ervices) is an easily remembered mnemonic that provides a framework for the evaluation of a patient's functional status and home environment. Expanded use of the telephone and telemedicine technology may allow busy physicians to conduct time-efficient “virtual” house calls that complement and sometimes replace in-person visits.

In 1990, the American Medical Association (AMA) reported that approximately one half of primary care physicians polled in a national survey indicated that they performed home visits. 1 Although most of the physicians surveyed perceived home visits to be an important service, the majority performed only a few such visits per year. 1 Consistent with these self-reported behaviors are data indicating that only 0.88 percent of Medicare patients receive home visits from physicians. 2 In addition, the Health Care Financing Administration reported charges for only 1.6 million home visits in 1996, an extremely small percentage of the total number of annual physician-patient contacts in the United States. 3 These statistics stand in sharp contrast to medical practice before World War II, at which time about 40 percent of patient-physician encounters were in the home. 4

The low frequency of home visits by physicians is the result of many coincident factors, including deficits in physician compensation for these visits, time constraints, perceived limitations of technologic support, concerns about the risk of litigation, lack of physician training and exposure, and corporate and individual attitudinal biases. Physicians most likely to perform home visits are older generalists in solo practices. Health care providers who have long-established relationships with their patients are also more likely to utilize house calls. Rural practice setting, older patient age and need for terminal care correlate with an increased frequency of home visits. 5

Rationale for Home Visits

Studies suggest that home visits can lead to improved medical care through the discovery of unmet health care needs. 6 – 8 One study found that home assessment of elderly patients with relatively good health status and function resulted in the detection of an average of four new medical problems and up to eight new intervention recommendations per patient. 8 Major problems detected included impotence, gait and balance problems, immunization deficits and hypertension. Significantly, these problems had not been expected based on information obtained from outpatient clinic encounters. Other investigators have demonstrated the effectiveness of home visits in assessing unexpected problems in patient compliance with therapeutic regimens. 9 Finally, specific home-based interventions, such as adjusting the elderly patient's home environment to prevent falls, have also yielded health benefits. 10

Beyond the potential benefit of improved patient care, family physicians who conduct home visits report a higher level of practice satisfaction than those who do not offer this service. 5 Physicians with more positive attitudes about home visits are more likely to have conducted house calls during training. 11 Faculty mentorship and longitudinal exposure in training appear to be important for the development of positive attitudes toward home visits. 5 However, in 1994, only 66 of 123 medical schools offered specific instruction in the role and conduct of home visits. 12 Although 83 percent of the medical schools offered students the opportunity to participate in home visits, only three of the 123 schools required students to make five or more such visits. 12

Home Health Care Industry

Physician home visits have largely been supplanted by the extensive use of home health care services, a $22.3 billion industry that augments a medical system largely comprising facility-based health care providers. 13 The mean annual frequency of home health referrals was 43 per provider in a study published in 1992. 14

Family physicians have authorization and supervision responsibilities for a broad spectrum of skilled services that can be offered in the home. Such services include home health nursing, assistance from home health aides, and physical, occupational and speech therapy. Other health care support services are provided by medical supply companies, respiratory therapists, nutritionists, intravenous therapy services, hospice organizations, respite care services, Meals-on-Wheels volunteers and bereavement support staff. Family physicians also work extensively with social workers, who provide invaluable assistance in coordinating these services.

Thus, effective use of home care services has become a core competency for family physicians. In 1998, the AMA published the second edition of Medical Management of the Home Care Patient: Guidelines for Physicians . 15 The basic physician home care responsibilities outlined in that document are listed in Table 1 . 15

Recent data suggest that many physicians do not have the necessary knowledge and skills to perform these tasks effectively. For example, a survey found that 64 percent of physicians who had signed claims for care plans that were later disallowed had relied on a home health agency to prepare the plan of care, and 60 percent were not aware of the homebound requirement for home services. 16 Thus, increased physician education about home visits seems necessary if the responsibilities and obligations created by the expansion of home health care industry are to be fulfilled.

Types of Home Visits

The four major types of home visits are illness visits, visits to dying patients, home assessment visits and follow-up visits after hospitalization ( Table 2 ) . 17 , 18 The illness home visit involves an assessment of the patient and the provision of care in the setting of acute or chronic illness, often in coordination with one or more home health agencies. Emergency illness visits are infrequent and impractical for the typical office-based physician.

The dying patient home visit is made to provide care to the home-bound patient who has a terminal disease, usually in coordination with a hospice agency. The family physician can provide valuable medical and emotional support to family members before, during and after the death of a patient in the home environment. Family assistance involves evaluating the coping behaviors of survivors and assessing the medical, psychosocial, environmental and financial resources of the remaining family members.

The assessment home visit can also be described as an investigational visit during which the physician evaluates the role of the home environment in the patient's health status. An assessment visit is often made when a patient is suspected of poor compliance or has been making excessive use of health care resources. Medication use can be evaluated in the patient who is taking many drugs (polypharmacy) because of multiple medical problems. Evaluation of the home environment of the “at-risk” patient can reveal evidence of abuse, neglect or social isolation. Patients and family members who are trying to cope with chronic problems such as cognitive impairment or incontinence may particularly benefit from this evaluation. A joint assessment home visit facilitates coordination of the efforts of home health agencies and the physician. Finally, an assessment home visit is invaluable in assessing the need for nursing home placement of a frail elderly patient with uncertain social support.

The hospitalization follow-up home visit is useful when significant life changes have occurred. For example, a home visit after the birth of a new baby provides an excellent opportunity to discuss wellness and prevention issues and to address parental concerns. A home visit after a major illness or surgery can be useful in evaluating the coping behaviors of the patient and family members, as well as the effectiveness of the home health care plan.

Many aspects of physician home care have not been evaluated in the literature. However, it seems likely that properly focused and conducted home visits can enhance home health care delivery, improve patient satisfaction and strengthen the doctor-patient relationship.

Conducting the Home Visit

Equipment and planning.

Most equipment for a home visit can still be carried in the family physician's “black bag” ( Table 3 ) . Some additional items may be acquired from the patient's home.

One of the keys to conducting a successful home visit is to clarify the reason for the visit and carefully plan the agenda. Preplanning allows the physician to gather the necessary equipment and patient education materials before departure. The physician should have a map, the patient's telephone number and directions to the patient's home. The physician, patient and home care team should set a formal appointment time for the visit. Coordinating the house call to allow for the presence of key family members or significant others can enhance communication and satisfaction with care. Finally, confirming the appointment time with all involved parties before departure from the office is a common courtesy to the family as well as a wise time-management strategy.

HOME VISIT CHECKLIST: “INHOMESSS”

The INHOME mnemonic was devised to help family physicians remember the items to be assessed during the home visit directed at a patient's functional status and living environment. 19 This mnemonic can be expanded to “INHOMESSS,” which incorporates investigations of safety issues, spiritual health and home health agencies ( Table 4 ) . 19

Immobility . Evaluation of the patient's functional activities includes assessment of the activities of daily living (bathing, transfer, dressing, toileting, feeding, continence) and the instrumental activities of daily living (using the telephone, administering medications, paying bills, shopping for food, preparing meals, doing housework). The physician can ask the patient to demonstrate elements of the daily routine, such as getting out of bed, performing personal hygiene and leisure activities, and getting in and out of a car. Corrective interventions can be directed at any deficiencies noted. For example, modified pill-bottle caps can be obtained for the patient who has trouble opening medication containers because of a condition such as arthritis.

Nutrition . The physician should assess the patient's current state of nutrition, eating behaviors and food preferences. Permission to look in the refrigerator or cupboard can be obtained by asking open-ended but directed questions. For example, the physician might say, “We have been working hard on your diet to control your diabetes. Would you mind if I look in your refrigerator to see the types of foods you eat?” Improvements in product labeling allow the physician to assess serving sizes and the nutritional value of foods with relative ease. Healthy food preparation techniques can also be reviewed with the patient.

Home Environment . The patient's home environment should allow for privacy, social interaction and both spiritual and emotional comfort and safety. A safe neighborhood with close proximity to services is important for many older patients. The home may reflect pride in the patient's family and past accomplishments and reveal the patient's interests and hobbies. The physician should not make assumptions about social class or material wealth based on the patient's physical environment.

Other People . Having the patient's social support system present at the home visit clarifies the roles and concerns of family members. During routine visits, the physician can assess the availability of emergency help for the patient from family members and friends and can clarify specific issues, such as who is to serve as surrogate for the patient in the event of incapacitation. Discussion of a durable power of attorney and a living will may be more comfortably performed during the home visit than in the usual clinic visit. Evaluation of the caregiver's needs and risk of burnout is critically important.

Medications . To remedy or avoid polypharmacy, the physician must evaluate the type, amount and frequency of medications, and the organization and methods of medication delivery. An inventory of the patient's medicine cabinet can provide clues to previously unidentified drug-drug or drug-food interactions. A home medication review can also allow a direct estimate of patient compliance, uncover evidence of “doctor shopping” and identify the use or abuse of over-the-counter medications and herbal remedies.

Examination . The home visit should include a directed physical examination based on the needs of the patient and the physician's agenda. Practical, function-related examination techniques may include having the patient demonstrate getting on and off the toilet or in and out of the bathtub. The physician can have the patient demonstrate proper technique for the self-monitoring of blood glucose levels. In addition, the physician can weigh the patient and obtain a blood pressure measurement. In-person correlation of home and office measures provides useful information for future telephone and clinic contacts.

Safety . Common home safety issues are listed in Table 5 . The goal of the home safety assessment is to determine whether the patient's environment is comfortable and safe (no unreasonable risk of injury). To raise the subject, the physician should simply state the intention to identify and help modify potential safety hazards. For example, furniture placement or throw rugs may create problems for an elderly patient with gait instability, or the tap water may be so hot that the patient is at risk for scald injury. 20

Spiritual Health . If the home contains religious objects or reading materials, the physician can ask about the influence of spiritual beliefs on the patient's sense of physical and emotional health. This information may provide the impetus, as desired by the patient, for a discussion of spirituality as a coping and healing strategy.

Services . Having members of cooperating home health agencies present for the house call can enhance communication and cooperation among the physician, patient and agencies. Existing orders can be clarified, priorities for future care can be established and other perspectives on the care plan can be solicited. The patient's relationship with home health agency providers can also be assessed.

Elements of the INHOMESSS mnemonic may be used independently, based on the needs of the patient and the physician's agenda. For example, the physician may wish to focus on polypharmacy and safety in a patient with a recent fall, or to assess mobility and the extent of social support in a patient with newly diagnosed Alzheimer's disease. Figure 1 presents the major elements of the home visit in a checklist format that facilitates comprehensive assessment.

INTEGRATING HOME VISITS INTO CLINICAL PRACTICE

Lack of reimbursement and the busy pace of office practice are the reasons commonly cited for not conducting house calls. Poorly organized, sporadic home visits may indeed interfere with clinical practice. Therefore, it is important to develop a systematic approach for planning home visits. 21

Most practices will benefit from using home visits with patients who have difficulty accessing outpatient facilities because of sensory impairment, immobility or transportation problems. Removing such logistically difficult appointments from the clinic schedule and performing them in the home setting may actually enhance clinic functioning. Clustering home visits by geographic location and within defined blocks of time may also improve efficiency. Finally, nurse practitioners and physician assistants can conduct visits as part of a home health care delivery team.

The 1999 Current Procedural Terminology codes and corresponding Medicare reimbursement rates for common types of home visits are listed in Table 6 . 22

Telephone Calls and Telemedicine

Proactive telephone calls are an underutilized method of conducting highly focused and time-efficient “virtual” home visits. 23 Provider-initiated telephone calls can be used to reassure family members after a patient has had an acute illness or has been hospitalized. 23 These calls can also be helpful in reinforcing patient compliance with new medications, following patients with chronic diseases and reducing inappropriate use of primary care clinic or office services. 24

Telemedicine is the use of communication technologies, such as two-way video-conferencing, to provide patient care across distances. A variety of institutions are exploring these technologies as methods of delivering health care in the home. 25 , 26

Final Comment

As fewer patients are admitted to hospitals and hospital stays become ever briefer, the medical complexity of home care will increase, as will the demand for both in-person and “virtual” physician home visits. Physicians interested in obtaining additional information about home care provision can contact the American Academy of Home Care Physicians (P.O. Box 1037, Edgewood, MD 21040; Web address: http://www.aahcp.org/ ).

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Meyer GS, Gibbons RV. House calls to the elderly: a vanishing practice among physicians. N Engl J Med. 1997;337:1815-20.

Boling PA. House calls [Letter]. N Engl J Med. 1998;338:1466.

Starr P. The social transformation of American medicine. New York: Basic Books, 1982:359.

Adelman AM, Fredman L, Knight AL. House call practices: a comparison by specialty. J Fam Pract. 1994;39:39-44.

Arcand M, Williamson J. An evaluation of home visiting of patients by physicians in geriatric medicine. Br Med J. 1981;283:718-20.

Fabacher D, Josephson K, Pietruszka F, Linderborn K, Morley JE, Rubenstein LZ. An in-home preventive assessment program for independent older adults: a randomized controlled trial. J Am Geriatr Soc. 1994;42:630-8.

Ramsdell SW, Swart J, Jackson JE, Renvall M. The yield of a home visit in the assessment of geriatric patients. J Am Geriatr Soc. 1989;37:17-24.

Bernardini J, Piraino B. Compliance in CAPD and CCPD patients as measured by supply inventories during home visits. Am J Kidney Dis. 1998;31:101-7.

Tideiksaar R. Environmental adaptation to preserve balance and prevent falls. Top Geriatr Rehabil. 1990;5:178-84.

Knight AL, Adelman AM, Sobal J. The house call in residency training and its relationship to future practice. Fam Med. 1991;23:57-9.

Steel RK, Musliner M, Boling PA. Medical schools and home care. N Engl J Med. 1994;331:1098-9.

Goldberg AI. Home healthcare: the role of the primary care physician. Compr Ther. 1995;21:633-8.

Boling PA, Keenan JM, Schwartzberg JG, Retchin SM, Olson L, Schneiderman M. Home health agency referrals by internists and family physicians. Am Geriatr Soc. 1992;40:1241-9.

American Medical Association. Medical management of the home care patient: guidelines for physicians. 2d ed. Chicago: The Association, 1998:1–60.

Klein S. Guidance for home care physicians. Am Med News. 1998;41:5-6.

Cauthen DB. The house call in current medical practice. J Fam Pract. 1981;13:209-13.

Scanameo AM, Fillit H. House calls: a practical guide to seeing the patient at home. Geriatrics. 1995;50:33-9.

Knight AL, Adelman AM. The family physician and home care. Am Fam Physician. 1991;44:1733-7.

Huyer DW, Corkum SH. Reducing the incidence of tap-water scalds: strategies for physicians. Can Med Assoc J. 1997;156:841-4.

American Academy of Home Care Physicians. Making house calls a part of your practice. Edgewood, Md.: American Academy of Home Care Physicians, 19981;1–35.

Kirschner CG, ed. Current procedural terminology: CPT. Standard ed. Chicago: American Medical Association, 1999:26–8.

Studdiford JS, Panitch KN, Snyderman DA, Pharr ME. The telephone in primary care. Prim Care. 1996;23:83-102.

Wasson J, Gaudette C, Whaley F, Sauvigne A, Baribeau P, Welch HG. Telephone care as a substitute for routine clinic follow-up. JAMA. 1992;267:1788-93.

Jerant AF, Schlachta L, Epperly TD, Barnes-Camp J. Back to the future: the telemedicine house call. Fam Pract Management. 1998;5:18-22.

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Home Visits

When is the last time you visited or called a parent or guardian without bad news?

Administrators

How are you equipping teachers to build relationships with families through visits? Learn the benefits of home visits and best practices for how to prepare for and conduct them.

Best Practices

These are some best practices for teachers and administrators concerning home visits:  

• Visits should be voluntary for educators and families, but administrators should seek at least 50 percent participation from a school’s staff.  
• Home visits should always be arranged in advance. It’s helpful for schools to decide if they want educators to visit families once or twice per year and whether that first visit will take place before the school year begins. Some districts also follow up home visits with family dinners at the school to continue deepening school-family ties.  
• If possible, schools should compensate educators for their home-visit work and train them effectively.  
• Educators should visit in teams of two. In some cases, teachers partner with other teachers, social workers or the school nurse to help address a student’s well-being in a more comprehensive manner.  
• It’s important that educators visit a cross-section of students—ideally all of them—rather than target any particular group.  
• The goal of the first home visit is to build relationships. Educators should talk about families’ hopes and aspirations for their students.

Note to teachers: Take extra care when communicating with immigrant families about visiting their homes. Make it clear in advance that you are not from any government immigration agency, such as ICE, and that you will not talk with any such agency. Also, do not ask about immigration status during the visit—or at any other time.

The Benefits

Family engagement contributes to a range of positive student outcomes, including:

• Improved achievement;
• Decreased disciplinary issues;
• Improved parent- or guardian-child and teacher-child relationships.

Different Families, Different Visits

Just as instruction is differentiated, so too are home visits. Depending on the needs of the student and family and the previous history of the teacher-family relationship, a home visit might be:

• A formal conversation on the couch;
• A meal together;
• A guided tour of a home (including favorite toys and hangout spots);
• Walking the family dog in the park or another excursion to an agreed-upon meeting place.

Note: Keep in mind that some families may not be comfortable having guests in their homes and would prefer to meet somewhere else. In this case, you could offer the school or another location as a meeting place.

Story From the Field: Keep Your Eyes On the Speaker

“I once went on a home visit to a trailer home. We sat at the kitchen table, and I was astounded to see a hole around a foot and a half in diameter right in the middle of the kitchen, through which I could see the dirt underneath the trailer. However, as mortified as I was, I thought that it probably was even more mortifying for the mother who so kindly received me. She was probably embarrassed and the least I could do was to keep my eyes on her and focus on our conversation instead of on the material distractions around us. My job is to focus on the human being, not on the dehumanizing conditions many people have to live in.”

—Barbie Garayúa-Tudryn, elementary school counselor and TT Advisory Board member

Home Visit Checklist:

• Participate in home-visit training.
• Call each student’s home, and explain the purpose of the visit.
• Schedule the visit.
• Determine if a translator is needed. The student should not serve as a translator.
• Confirm the day before or the day of the home visit.
• Before the visit, reflect on the reason you’re there in the first place: to build a relationship with the family and collaborate with them for the well-being of the child.
• The visit should be 20-30 minutes long.
• Bring a partner.
• Get to know the family. Find out if they have other children in school.
• Talk about the family’s hopes for their students and share yours.
• Avoid taking notes or bringing paperwork, which can make families feel as if they are being evaluated and can cause nervousness and disengagement.
• If you need to share paperwork, wait 20-30 minutes before delivering it or plan to send it at a later date.
• Ask the family what they need from you, and make a plan to connect again in the future.
• Make a phone call or send a text or note thanking the parents or guardians for the meeting.
• Invite the family to an upcoming event.
• Document the visit, and share takeaways with appropriate stakeholders.
• Follow up with any resource needs that came up during the visit.

To learn more, read “ Meet the Family ” and watch our on-demand webinar Equity Matters: Engaging Families Through Home Visits .

Critical Training Elements for Administrators

Training and preparing for a home visit can be as important as the visit itself. Consider these pointers from the experts when designing professional development for your home-visit program.

• Review logistics , such as how to make contact, how and when to schedule visits, whether and how to record discussions with families, and what to do with the documentation and data.  
• Remind teachers to leave assumptions behind and keep an open mind regarding each family, their culture and their values.  
• Address implicit bias and the impact it can have on what educators or families will perceive during the home visit. To learn more about implicit bias, view our on-demand webinar Equity Matters: Confronting Implicit Bias .  
• Some prior knowledge is essential , such as whether a translator will be necessary (it is not appropriate to use the student as a translator), whether the family has access to a working phone or if the child lives between two households.  
• Coach teachers to establish the purpose for the visit ahead of time. Goals should focus on getting to know the child as a learner and setting the stage for partnership, not on problematic behavior or performance.  
• Model how to talk about both the student and the family. Some families may have significant needs. Connecting them to resources can benefit their child’s learning.

For more information, explore the work of The Parent Teacher Home Visit Project and the Family and Community Engagement Team at Denver Public Schools.

• Student sensitivity.

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PM Modi US Visit Highlights: Modi and Biden engage in bilateral talks in Greenville, Delaware

PM Modi US Visit Highlights: Prime Minister Narendra Modi has kicked off a three-day visit to the United States, where he will participate in the Quad Summit hosted by President Joe Biden, deliver an address at the United Nations' 'Summit of the Future,' and hold high-level discussions with CEOs of leading American tech companies. This visit, his first since securing a third term, is aimed at strengthening diplomatic ties and advancing key global and regional partnerships.

That’s a wrap for today’s coverage of PM Modi's US visit.

Follow CNBC-TV18 for more updates and developments. We’ll see you tomorrow!

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Bangladesh’s Foreign Adviser Touhid Hossain on Saturday said that Chief Adviser Muhammad Yunus will not be meeting with Indian Prime Minister Narendra Modi on the sidelines of the UN General Assembly in New York, according to media reports.

Hossain, former foreign secretary of Bangladesh, said he would hold a bilateral meeting with India’s External Affairs Minister S Jaishankar to advance the relationship between the two neighbours, The Daily Star newspaper reported.

At a press briefing at the foreign ministry in the afternoon, Hossain said, “Sorting out all issues, we want to further advance our relationship based on mutual respect and fairness.” “Our meeting with Jaishankar is almost certain. We have to acknowledge that there is a certain level of tension in our relations with India. To resolve any issues, we can’t simply deny their existence. We will definitely try to move past the tension and establish a working relationship,” Hossain said, according to The Dhaka Tribune newspaper. (PTI)

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As PM Modi lands in Philadelphia to begin his three-day US visit, a member of the Indian diaspora Dr Dilip Joshi in Wilmington, Delaware says, “It has never happened before that leaders of four countries have come to Wilmington, Delaware. We consider ourselves lucky that our PM has come here with our President.”

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PM Modi's US visit live: Wilmington’s Indian community thanks Modi for global recognition

#WATCH | Another member of the Indian diaspora outside Hotel duPont in Wilmington, Delaware says, “It is a privilege to have Modi ji in our state. We are honoured. Thank you Modi ji for everything you have done for India and for bringing us up to recognition on the world stage.” pic.twitter.com/Iat1vs4tUh — ANI (@ANI) September 21, 2024

Detroit Lions coach Dan Campbell looking to sell home after unexpected guests show up

Detroit Lions coach Dan Campbell said he's in the process of selling his family's suburban Motown home after amateur sleuths learned where they reside.

"The home is beautiful,” Campbell  told Crain’s Detroit Business , speaking about his family's now former pad. “It’s just that people figured out where we lived when we lost.”

The Lions, the longtime laughingstocks of pro football, are anything but a joke in their fourth season under Campbell and a legitimate Super Bowl contender.

The Lions have come 3-13 to 9-8 to 12-5 in Campbell's first three campaigns as the coach and his wife had been enjoying life in the Detroit suburb of Bloomfield Hills.

During the Lions' run to the NFC title game last season, they lost, 20-19, to the Dallas Cowboys on Dec. 30, 2023.

In a typical Lions season, losing to the Cowboys would simply be called Sunday. But in this new era of Lions football, winning has become expected.

That loss triggered a string of pranks that has Campbell concerned for his privacy and the safety of his family.

Ashley Crain, who represented the Campbells in this sale, declined to detail the pranks but said they bordered on "scary."

"It was like handymen pretending to come do some work on their house," Crain told NBC News on Friday. "And it was actually a little bit scary because they're grown men and their 18-year-old daughter was at the house. Obviously, when (the Lions are) on the road, he's not home."

That prank didn't lead to any criminal charges, but she said the coach and his family now live in more hard-to-find locale.

"They're a little further out so they could have a little more privacy," Crain said.

Campbell and his family moved to another spot in Oakland County before their "beautiful" house was listed for sale for $4.5 million .

As of Friday, the property on Quarton Road, about 23 miles north of Ford Field , was listed as "pending."

The home was built in 2013 for one-time Detroit Red wings great Igor Larionov, who is in a Hockey Hall of Fame .

Senior Breaking News Reporter

Another Mayor Adams aide comes under federal scrutiny as officials visit her home and family

Published Sep 20, 2024

Modified Sep 20, 2024

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Federal law enforcement officials on Friday issued a subpoena to a top aide in the Adams administration and visited a building where her parents live, according to surveillance footage provided to Gothamist and a report by the Associated Press.

The Associated Press reported that federal prosecutors issued the subpoena to Director of Asylum Seeker Operations Molly Schaeffer. A doorman at her parents’ building who spoke to Gothamist confirmed that law enforcement officials visited on Friday morning.

The purpose of the visit was not clear. There are at least four ongoing federal investigations into Mayor Eric Adams’ campaign and his top aides. Earlier this month, federal agents reportedly seized the phones of a top mayoral adviser who had handled contracts tied to the migrant crisis.

A spokesperson for the U.S. attorney for the Southern District of New York declined to comment. The office for the U.S. attorney for the Eastern District did not immediately respond to a request for comment.

Surveillance video footage obtained by Gothamist shows two law enforcement officials walking into the building, one holding a small briefcase. The doorman said the officials went upstairs and were inside the building for about 10 minutes. He said he did not see them leave with any boxes.

A representative for the building’s management office declined to comment.

Reached by phone, Schaeffer denied that officials had searched her own apartment, but did not deny that officers had visited her.

“Searching is a strong word,” she said, and referred questions to a City Hall spokesperson. Her father did not return phone messages.

Mayor Adams walks with Molly Schaeffer, center, while visiting asylum seekers taking shelter at James Madison High School in Brooklyn on January 10, 2024.

Fabien Levy, the deputy mayor for communications, declined to answer multiple questions about the visits.

“While we won’t comment on an ongoing investigation, as we have repeatedly said, we expect all team members to fully comply with any ongoing inquiry,” Levy said in a statement. “Molly Schaeffer is an integral part of our team and works hard every day to deliver for New Yorkers.”

Schaeffer has worked closely with Adams on city services for its migrant population. The mayor said she accompanied him to a meeting last month with a group of Brooklyn residents complaining about migrant shelters in their neighborhood.

She has been in her current role for about a year and half. Prior to that, she was the deputy chief of staff to Adams and senior emergency adviser.

Adams has referred to Schaeffer as a member of a team working on migrant issues that includes senior adviser Timothy Pearson. Pearson was among those whose phones were seized earlier this month, according to multiple reports.

Pearson, a close friend of Adams, was in charge of overseeing emergency contracts, selecting sites for shelters and managing their operations. He has been at the center of several controversies, including a lawsuit alleging that he aimed to make money off of the contracts.

The lawsuit filed over the alleged misconduct in Manhattan Supreme Court claims that Pearson said: “People are doing very well on these contracts. I have to get mine. Where are my crumbs?”

The city’s emergency no-bid contracts for migrant services total $3 billion and have been criticized for mismanagement and waste. Earlier this year, the city said it would no longer employ DocGo, a medical services company that was accused of improper conduct, including hiring subcontractors who mistreated and lied to migrants and threw out massive amounts of food.

Speaking with reporters on Tuesday, the mayor credited Pearson for his cost analysis on the migrant crisis.

“We asked him to go in and look in and we saved hundreds of millions of dollars by bringing down the costs, everything from security contracts to other contracts,” he said.

Pearson is also being sued for alleged sexual harassment and retaliation by former and current NYPD officers who worked under him. He is under investigation for a physical altercation with shelter staffers.

Adams has repeatedly defended Pearson when faced with questions about his conduct. Their friendship stretches back decades to their days in the NYPD.

This story has been updated with additional information about senior mayoral aide Timothy Pearson and the city's handling of emergency contracts for migrant services.

Charles Lane and Samantha Max contributed reporting.

Elizabeth Kim is a reporter on the People and Power desk who covers mayoral power. She previously covered the pandemic, housing, redevelopment and public spaces. A native of Queens, she speaks fluent Mandarin. Got a tip? Email [email protected]

Bahar Ostadan covers the NYPD and public safety. Got a tip? Email [email protected] or message Bahar on Signal at 646-740-7335.

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O's blast season-high 5 homers to back Burnes' gem

BALTIMORE -- James McCann hit his second home run on Friday -- the Orioles’ season-high fifth of the night -- and retreated to the dugout. As per 2024 tradition, his solo blast prompted an individual visit to the Homer Hydration Station, where the home run hitter and anybody on base at the time get to drink water from the orange-and-black, octopus-like hose prop.

Only this time, the hose McCann tried to drink from popped out of the contraption.

Evidently, it wasn’t built for this type of heavy usage.

“I guess not,” McCann said with a smile. “We’ve been wearing it out a little bit.”

That they have, because the O’s -- whose “mojo” had “drifted away” as general manager Mike Elias put it earlier in the week -- appear to be rounding back into form. And at quite an opportune time to do so.

Baltimore’s homer-heavy offensive performance backed a seven-inning scoreless gem from ace Corbin Burnes in a 7-1 victory over red-hot Detroit at Camden Yards on Friday night. McCann and Colton Cowser each went deep twice for the O’s, who won consecutive games for the first time since a three-game run from Sept. 1-3.

The Orioles (86-68), who have eight games remaining, still have a chance to catch the Yankees (90-64) in the American League East , as their deficit sits at four. The O’s are also comfortably atop the AL Wild Card standings , with a chance to clinch a postseason berth as soon as Saturday.

It felt like Baltimore (28-30 in the second half) began a resurgence on Thursday afternoon, when Anthony Santander came to the rescue with a heroic walk-off homer in a 5-3 win vs. San Francisco . One swing seemingly brought an entire vibe shift for the defending AL East champs.

• Complete coverage: Orioles’ clinch scenarios, tiebreakers, key games and more

Santander carried the good feelings over into Friday, hitting a two-run homer off Tigers opener Tyler Holton to give the Orioles a first-inning lead.

“That was really, honestly, a turning point in the game,” manager Brandon Hyde said. “You get Burnes with a 2-0 lead there right away.”

In September, Burnes hasn’t needed much support. The 29-year-old right-hander threw seven scoreless innings in Detroit last Saturday, then had a repeat performance on Friday. His eight strikeouts marked his most since an 11-K showing vs. the Mariners on May 19.

After struggling to a 7.36 ERA over five starts in August -- by far his worst month of the season -- Burnes has recorded a 1.08 ERA through four starts this month.

“I think we’ve had good stuff all year. Just haven’t been able to command it where we wanted to,” said Burnes, who has a 2.95 ERA over 31 starts. “So now, we’ve had good stuff and we’re commanding it.”

The Orioles’ offense made sure Burnes could cruise with their best showing in quite some time. In fact, it was the first time they scored more than five runs since a 9-0 victory vs. the White Sox on Sept. 3, and it was their first game with more than two homers since Aug. 7.

From April 5-Aug. 7, Baltimore hit three-plus homers 28 times. So it felt like a return to the stellar first half for the O’s, who still lead MLB with 224 long balls.

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“Hitting is contagious, right?” McCann said. “So all it takes is that one guy to come up with a big hit, and then, next thing you know, it just follows onto everyone else in the lineup.”

Santander started it, before Cowser led off both the second and sixth with home runs. McCann hit a two-run blast in the fourth, followed by his solo shot in the sixth. Cowser and McCann became the first Orioles teammates to hit multiple homers in the same game since June 19, 2021, when Ryan Mountcastle had three and Cedric Mullins slugged two vs. the Blue Jays.

Baltimore’s five home runs were its most in a game at Camden Yards since it hit five here on Sept. 3, 2022. The club hadn’t recorded any five-homer performance since Sept. 9, 2023.

Entering Friday, the Tigers were an MLB-best 25-10 since Aug. 11, having won nine of their previous 11. So it was quite a statement for the O’s (who lost two of three in Detroit last weekend) to halt that momentum.

Perhaps this two-game win streak truly is the start of positive momentum in Baltimore.

“We’ve played good baseball the last few days. If we come out and play like that, we’re a tough team to beat,” Burnes said. “Now, it’s just about keeping it going and playing our baseball and not worry about what’s going on. We’ve got eight games left, so we’ve got to kick it into gear if we want to try to get the division. At this point, we know we’re going to be in the postseason, and that’s what’s more important.”