Doctors Make House Calls Again

When Medicare put out a call for innovative ideas from the nation’s health-care providers, the doctors at Santa Barbara’s Palliative Care Consultants recalled what their senior patients had been telling them. “What we were hearing over and over was that seniors were dissatisfied with their health-care options, particularly in a hospital setting, but they were going there because it’s the only place where they can access care when they get sick,” said Dr. Michael Bordofsky, a partner in the practice. “We believed there was a big population of seniors who would prefer to get care in their home, and if they were given an option to get rapidly accessed care when they got sick, they would utilize it.”

That was in 2012, and since then, Dr. Bordofsky, and his partners Drs. Dennis Baker and Eric Trautwein, with the help of Dr. Nancy Rikalo, devised a template for an on-call team of rapid-response nurses and palliative care professionals who would attend to immediate medical needs without the cost, discomfort, or embarrassment of an ambulance or a trip to the emergency room. Their program, Doctors Assisting Seniors at Home (DASH), won an award of $4.2 million from the Centers for Medicare & Medicaid Services — only 107 awards were given out of 3,000 applicants nationwide. DASH has so far proven very successful, reporting over 1,600 responses to date with an average of a 40-minute wait time; a 38 percent drop in visits to the emergency room; and a 41 percent reduction in hospitalizations among enrollees.

The service is open to seniors living in Santa Barbara, Goleta, Montecito, and Summerland, and Bordofsky hopes to expand the idea, either countywide or by inspiring similar programs across the nation. He cites the low cost — $60 for an individual subscriber, $90 for a couple, and free for low-income or MediCal seniors — as an incentive for insurance companies to invest in the program. “Now they don’t have to pay for an ambulance or hospital visit,” he said.

DASH addresses medical needs, said Bordofsky, that were too pressing for an appointment but not severe enough to warrant an emergency room visit. The service may have particular appeal to the adult children of aging Santa Barbara residents, who often have to play the role of caretaker. “Some of the strongest advocates are the adult children who are giving the care; they are embroiled in the stress of meeting their parents’ needs,” Bordofsky said.

The program has also changed the sound and mood of some neighborhoods, he said. “In some of the low-income-housing communities where we’ve enrolled a number of people, they’ve been happy that they’re hearing fewer sirens, less paramedics coming through there. It changes the whole feeling in the place.”

Richard Arbagay, 91, and his wife, Rosita, have used the service eight or nine times since enrolling, and they reported a higher quality of care. “It wasn’t a matter of putting a thermometer and two minutes later backing up and leaving house; it was a very thorough investigation,” Richard said. “The staff, the doctor, and the nurses are very qualified, and if they don’t have any feeling that they’re doing the right thing, they don’t just blindly go ahead.”

“We were extremely happy with it. I hope that it will continue,” Rosita said.