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The doctor is in the house ... at assisted living facilities

POSTED: November 13, 2008 5:00 a.m.
TOM REED /The Times

Dr. Stephen Berry, right, talks with patient Herdnell Giddens at Dogwood Forest Assisted Living Center. Berry visits assisted living centers regularly.

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Most residents of assisted living facilities are old enough to remember a time when doctors made house calls.

Now, they can have that experience again.

Dr. Stephen Berry, an internal medicine physician who previously worked with a large medical group in Gainesville, has started a new practice that focuses exclusively on assisted living facilities.

"I met with a doctor in Tennessee who is doing this, and I saw that it can work," he said. "I had been thinking about this for a while. I had a lot of older patients, and it struck me that it’s such a hassle (for them to get to the doctor)."

Julie Ann Hamilton, executive director of the Dogwood Forest assisted living home on Thompson Bridge Road, said doctor appointments can be hard on the entire family.

"Family members have to take off work to drive (the resident) to the doctor," she said. "And if the person is not independent enough to be dropped off there, the family member has to stay and wait with them."

Last month, Berry began seeing patients at the Dogwood Forest and Autumn Breeze assisted living facilities in Gainesville. He’s also trying to set up similar arrangements at several others.

"These patients are by definition homebound. They can’t do some activities of daily living by themselves," he said. "But assisted living facilities cannot give nursing care. The trend has been for patients to stay in assisted living as long as possible and avoid going to a nursing home."

But because there is no medical care offered on site, even getting a routine checkup requires traveling to a doctor’s office.

Now, Berry treats patients right in their rooms. And he’s equipped with far more than the "little black bag" that doctors used to carry in the old days.

"I have a laptop computer with electronic medical records," he said. "I have a box on wheels, about the size of a milk crate, plus a duffel bag with more equipment. I’ve got an EKG module that connects to my laptop, and I carry a limited amount of medications."

Berry said he’s able to do almost everything that he would do in an office-based practice. He can perform EKGs, draw blood, administer breathing treatments and give injections. He’s now working on an arrangement for portable radiology so he can do X-rays when necessary.

But his patients rarely need fancy tests. Usually he can diagnosis a problem just by talking to the patient and doing a simple physical exam.

If Berry were working in a typical medical practice, he would be under pressure to squeeze in as many appointments as possible. On average, a doctor spends less than 10 minutes with each patient.

But Berry has no such restrictions now.

"I spend up to an hour with new patients, and 30 minutes for follow-up visits," he said.

The majority of his patients are on Medicare. Berry charges them the same fee that they would pay for seeing a doctor in an office setting. Though he sees fewer patients per day, he’s able to earn income because he’s not paying employees.

"The keys are keeping the overhead low and seeing patients in a confined geographic area," he said.

Berry considered doing house calls at private homes. "But the problem with that is that you spend so much time in the car, it’s not financially feasible," he said. "Assisted living homes are ideal because you have a lot of patients all in one place."

He typically visits each facility one or two days per week, but he also can be called in if a patient is ill and needs to be seen immediately.

"It saves them visits to an ER or a Quick Care," said Hamilton. "Some of them are maintaining their regular primary care physician, but they use Dr. Berry for emergencies."

To make people aware of the new service, Hamilton sent out letters to all the residents and families, and held an introductory meeting so they could get acquainted with Berry.

"He’s excellent," she said. "Everyone has loved meeting him, and those who have been treated by him in the past are excited that he’s here. It’s kind of neat, because many of them remember the days when doctors did make house calls."


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