House calls: a practical guide to seeing the patient at home.

The physician and/or healthcare team is responsible for the planning, design, implementation, and authorization of home care services. Home visits are appropriate for elderly homebound patients and for those who are having problems at home, such as recent falls or suspected abuse. The home visit can provide valuable information that is not readily accessible in the office setting. At the home, the comprehensive geriatric assessment should include history and physical exam, plus a medication review, environmental evaluation, and assessment of functional status. Discussion with the family is also important, as caregiver burnout can adversely affect the well-being of the frail older patient living at home. Environmental modifications can improve home safety and reduce the risk for falls.