I had to share a health equity “aha moment.” In thinking about moving more health care services into patients’ homes, we have focused on a variety of use cases — from seniors who want to age in place to complex patients who need more disease management to working parents who would rather have a nurse visit their home than have their kids miss school for an appointment.
We overlooked something important – how care in the home can contribute to health equity. A brilliant contributor to the health-in-the-home movement just made it crystal clear how more care in the home will contribute to health equity – a change in the power dynamic between patient and provider.
A medical provider is a guest in the home of a patient, which changes the control equation for a patient who, when in an institutional setting, is within the authority of someone else. Communities of color disproportionately lack trust in the health care system, and understandably so. If you have been disenfranchised, why would you expect the health care system to be any fairer?
It’s different if a medical provider visits your home. It’s much easier to build trust with a patient in an environment more comfortable to them. Being in a patient’s home also affords the opportunity to interact with the patient’s caregiver, identify possible food insecurity, fall risks, unsafe social situations, and conduct medication reconciliation. The connection built through an interaction in the patient’s home can also help solidify a longer-term relationship that will contribute to better adherence to care plans, and improved care coordination.
It is realizations like these that reinforce how important it is that we give patients the option to choose their home as a site of care.