• 
• CLASS
• JOBS
• AUTO
• HOMES

House calls: HospiceCare offers in-home doctor visits

Photo

Photo by Bill Olmsted

Janesville Hospice doctor Bruce Agneberg checks the knee of patient Fred Weber during a recent home visit.

Photo

Photo by Bill Olmsted

HospiceCare's Dr. Bruce Agneberg visits with patient Fred Weber during a home visit. Agneberg is one of four doctors that make the home visits.

Photo

Photo by Bill Olmsted

Janesville Hospice doctor Bruce Agneberg checks the knee of patient Fred Weber during a recent home visit.

JANESVILLE — Reminiscent of an episode from a 1960s television show, the doctor was making a house call.

Except this action was set in the Janesville home of HospiceCare patient Fred Weber.

Armed with a stethoscope, flashlight and a listening ear, Dr. Bruce Agneberg pulled up an ottoman and began talking with Weber, 82, who suffers from Parkinson's disease. He listened to Weber's lungs and heart. He heard Weber and his family talk about what other health care professionals had told them about Parkinson's.

The conversation and the in-home exam gave Agneberg clues about the progression of Weber's disease. It gave him an opportunity to discuss Weber's knee pain from an earlier fall and a chance to talk with Weber's wife of 55 years, Ruth, about her husband's pain medications.

HospiceCare is best known for providing a team of professionals and volunteers partnered with a physician to care for patients who have life-limiting conditions and diagnoses of six months or less to live. But the program about a year ago began offering in-home visits for some of its nearly 600 patients who live in Rock, Walworth, Jefferson, Green and Dane counties.

"We've always done home visits but not with the specificity we do now," said Agneberg, chief medical officer for HospiceCare and fondly called Dr. B.

The primary reason for adding home visits is to help patients such as Fred, whose declining condition impedes a trip to the doctor's office, he said.

Nobody knows that better than Ruth, who is not able to take Fred anywhere because of his immobility.

"He's not able to get in the car. He'd have to go by ambulance. His knee is frozen tight," she said.

"Taking physician services to the home allows us to really get to know the person. It's a full circle of care—the family, with Fred in the center, and the rest is (HospiceCare) support. We're all together in the room for a better picture," Agneberg said.

Oftentimes, HospiceCare doctors discover medications are not being given or obtained in the way they were prescribed.

"Seeing the person allows us to do much better care," Agneberg said.

Bringing the service into homes has been remarkably well received, he said.

"It's incredibly helpful," said Mark Weber, Fred's son, who was home for a visit from out of state.

In-home visits allow Agneberg, who has been a hospice doctor since 1977, a deeper level of intimacy with the patient and family.

"It's a heart-to-heart conversation and really helps people in the last chapter of their lives," he said.

It allows open and compassionate end-of-life discussions that some physicians might find uncomfortable.

"With this disease, you'll notice as time goes on he'll eat and drink less. It's the body's way of saying we can't handle this anymore," he told Ruth and Mark, while sitting in the room with Fred.

"The goal is to support you in the decisions you make. The right decision is your decision. We'll walk through this with you," he told them in his soft, comforting voice.

Agneberg's visit allowed discussion on advanced care directives and planning about food and fluids. It gave him a sense of how the caregiver is doing.

"It gives us guidance and ideas to help make decisions. It's very comforting," Mark said.

Today, six in-home patient visits a day are made by one of five HospiceCare doctors, including Agneberg. Although 38 percent of HospiceCare's patients suffer from cancer, it also serves patients with ALS, Multiple Sclerosis and other end-stage neurological diseases and more end-stage dementia, Agneberg said.

"We fill in as an extension for primary care doctors," Agneberg said.

And for that, the Weber family is grateful.

The main objective is to keep Fred home, Ruth said. And with HospiceCare, that's happening.

"Without hospice," she said, "he would have to be in a facility, but he wants to be in his house."

And he is.

Who pays for HospiceCare services?

Medicare, Medicaid and most private insurances cover HospiceCare services.

With Medicare and Medicaid, there are minimal out-of-pocket expenses, even for medications, equipment and other high-cost items that often are needed in the last months of life.

In most cases, there are no bills, no claims and no financial surprises. No other Medicare program offers this level of comprehensive financial support. And for Medicaid hospice services, there are no out-of-pocket expenses. For care unrelated to a patient's primary diagnosis, Medicare and Medicaid will continue to provide their normal benefits.

The Medicare/Medicaid hospice benefit covers:

-- Skilled nursing services;

-- Volunteer services;

-- Physician visits;

-- Skilled therapies;

-- Home health aide visits;

-- Personal care;

-- Social work services;

-- Spiritual counseling;

-- Nutrition counseling;

-- Grief support for the family;

-- Medications for pain and other symptoms;

-- Durable medical equipment;

-- Inpatient care for symptom management;

-- Inpatient respite care to relieve caregiving responsibilities of the family.

Most commercial insurers, including HMO plans, also cover HospiceCare. Call HospiceCare to learn more.