"Only 5 Patients a Day..." Challenges Faced by Visiting Care Hospitals Accepting Deficits [My Home as a Senior House]

"Finding a Doctor for Home Visits Is Like Finding a Star"
How to Solve the Problem
Buk-gu, Gwangju: "Contacted 50 Clinics, Only 3 Agreed"
Neighborhood Clinics with Only One Doctor
Difficult to Form Home Visit Teams
Hiring Nurses and Social Workers Makes It Unprofitable
Limit of 100 Patients per Doctor per Month
With 20 Working Days, Only 5 Patients per Day... Regulations Must Be Eased
Interview with an Internal Medicine Director in Gwangju
Who Took on Home Visits Despite Others Refusing

On October 29 last year, Ahn Young-il (89) received a COVID-19 vaccine from the director of Malgeunsum Woori Internal Medicine at an apartment in Buk-gu, Gwangju Metropolitan City. Photo by Kang Jin-hyung

"Malgeunsum Woorinae Clinic," located in Buk-gu, Gwangju Metropolitan City, is a somewhat special hospital. Usually, patients visit hospitals, but here, medical staff visit the patients. It is a place that provides home visits for elderly patients who are too weak to walk. Receiving hospital diagnosis and prescriptions at home is very useful for the elderly. They need to stay healthy to live at home, and other care services like housekeeping, meals, and home repairs can be more effective.

The problem is that finding doctors who do home visits is like finding a needle in a haystack. Buk-gu, Gwangju, which is conducting an integrated care pilot project, faced the same issue. Two years ago, they contacted 50 primary care clinics in the district, but only three agreed, and Malgeunsum Woorinae Clinic was one of them. Director Kim Woo-jin started home visits that fall. While others hesitated, he decided to take on home visits more actively and added two more dedicated doctors last year.

Director Kim said, "It is practically difficult for a small neighborhood clinic to hire nurses and social workers to form a home visit team," and suggested, "The regulation limiting five patients per home visit doctor should be relaxed, and fees should be increased so that more doctors become interested in home visits."

- Why do doctors avoid home visits?

▲It is difficult for a single-doctor neighborhood clinic to conduct home visits. According to the Ministry of Health and Welfare guidelines, a home visit team must consist of one doctor, one nurse, and one social worker. In neighborhood clinics, nurse assistants usually work instead of nurses. To do home visits, a nurse must be newly hired, and there is a significant salary difference between nurse assistants and nurses. A social worker must also be hired, and their salary is quite high. Eight out of ten neighborhood clinics are run by a single doctor. Home visits can only be done during lunch or evening hours, with a maximum of 20 to 30 visits per month. In this situation, hiring two additional staff members (nurse and social worker) makes it impossible to turn a profit.

- What made you decide to do home visits despite this?

▲When Buk-gu Office contacted us, our clinic had three doctors. Having three doctors means one can be dedicated to home visits. Caring for elderly residents in a super-aged society so they can spend their remaining years comfortably at home is meaningful. Although personnel and operating costs would be high initially, we decided to try it even if it meant running at a loss. Currently (as of December last year), we have about 170 home visit patients. By fall 2023, the cumulative number will be around 220. We hired two more doctors dedicated to home visits.

- What needs to be improved to increase the number of home visit doctors?

▲The patient limit per home visit doctor should be relaxed. According to Ministry of Health and Welfare guidelines, one home visit doctor can see up to 100 patients. Assuming 20 working days, that means only five patients per day. If the number exceeds 100, another doctor must be hired. In apartment complexes, many patients can be seen in a relatively short time. Increasing the patient limit per doctor would allow home visit doctors to work morning and afternoon shifts and prevent hospital losses.

Director Kim Woo-jin (center) of Malgeunsum Woori Internal Medicine in Buk-gu, Gwangju Metropolitan City, and the visiting medical team are gathered to prepare for medical treatment. Photo by Malgeunsum Woori Internal Medicine

- How can the quality of home visits be improved?

▲The number of patients assigned to each nurse should be reduced. When a doctor visits a patient’s home once, the nurse accompanies the doctor and then visits the patient alone once more. This is an excessive burden for nurses. Service quality declines, and it becomes harder to find nurses willing to do home visits. Concerned about this, our clinic independently formed a home visit team with one doctor and two nurses. This increases personnel costs, but since we are doing it anyway, we want to provide good care.

- Are the fees adequate?

▲Currently, about 270,000 KRW is received per home visit patient. The fee per person is 130,000 KRW, and long-term care insurance matches 140,000 KRW. With 170 home visit patients, our monthly income is just under 50 million KRW. This pays the salaries of two doctors, four nurses, one social worker, and operates two vehicles. It is really tight. When we first started home visits, the number of patients was much lower, and we have not yet recovered from the initial deficit. The patient limit per doctor should be increased, and fees should be raised. The system must be changed so that home visit doctors are not disadvantaged compared to hospital doctors, which will gradually increase the number of home visit doctors.

- What have you felt while meeting patients at their homes?

▲Home visits can become monotonous over time. To avoid this, we established a principle among the medical staff: just as I visit hospital rooms 101 to 120 as a primary doctor, we should visit elderly patients’ homes in the same way. If a patient’s condition is poor, don’t just visit once; visit again the next day. We do not charge extra for additional visits. Once, while shopping at a mart on a weekend, I received a call from a grandfather who was receiving home visits, saying he had hives all over his body, and I rushed over. It requires a certain level of dedication.