Older Adult Care

不，病人不需要在家接受老年人上门服务. The patient should, however, 有一个功能或认知上的限制，使去办公室旅行变得困难.

老年人家庭电话转介是通过患者的主要提供者办公室, York Hospital walk-in or York Hospital Emergency Department. The Older Adult House Calls provider will see the patient for a one-time visit. In some instances, there will be short-term follow-up for acute medical issues. 评估和治疗记录在eCW中完成，并将转发给患者的初级保健提供者. If requested or deemed necessary based on clinical impression, 上门服务提供者可以在家访期间或之后通过电话联系提供者办公室，以协调患者的护理计划. Ongoing follow-up should be provided by the patient’s primary care office, and the patient should continue to see their primary care provider for regular visits.

上门服务的转介可以通过eCW使用外发转介功能进行. The referral should include the reason the visit is being requested, pertinent background information regarding the patient, goals of care if known, and any known safety concerns in the home.

电话和电话会面总是受欢迎的，可以提供额外的信息，可以帮助开始建立上门服务的过程. However, 还需要转介到eCW，因为这用于跟踪目的，并有助于确保所有转介都得到处理. If you are outside the York Hospital medical record, please fax appropriate referral documentation to our office at (207) 384-7929.

Once a referral is received, 老年人上门服务提供者将在1个工作日内与患者联系, and a patient house call visit will typically be scheduled within 1-2 weeks. 访问的时间和日期将记录在转介中，以供参考和跟踪. Once the patient is seen, a note will be documented in eCW and then forwarded to the primary care provider. 任何额外的随访或护理协调需要与初级保健办公室沟通.

Acute psychiatric episodes do not fall under the scope of the House Calls Program. Also, 上门拜访的需要不应该仅仅基于交通的可用性或与天气有关的挑战. Labs can be collected at visits as part of the patient’s care plan, 只要评估也在进行，并且访问不仅仅是为了实验室收集.

如果上门服务提供者因为其他原因已经见过病人，则可以将疫苗作为就诊的一部分. 上门服务提供者不能仅仅为了接种疫苗而出诊.

Yes, the House Calls provider can see patients who are being followed by the VNA, 除了VNA之外，只要有明确的高级实践提供者参与的特定需求.

On a case-by-case basis, 上门服务提供者在病人出院后进行随访可能是合适的. 初级诊所的病例管理人员或初级保健提供者可以联系上门服务的执业护士来讨论这些类型的就诊. Inpatient providers are welcome to send appropriate referrals to our office at (207) 382-7292.

老年人家庭电话热线电话号码由老年人服务分诊护士接听. If the patient has an open referral to the House Calls program, 老年人分诊护士将协助病人安排一次家访预约. If there is no open referral, 病人将被引导到他们的初级保健办公室，讨论他们的症状，并确定是否适合出诊以满足他们的需要.