Primary care medical house calls allow people to avoid the hassle of going to the doctor's office. This primary care home-based care also allows geriatric patients to maintain independence while remaining in the comfort of their home. In addition, it is an effective way to avoid hospitalizations, re-admissions, and long-term care placement.

What Is a Transitional Care Program?

At Metro Medical Direct, our transitional care program bridges the gap between hospital discharge and home. Most hospital re-admissions occur while awaiting a follow-up appointment with the physician's office. 

Our home-based integrative primary care (HBIPC) program includes psychiatric care, which greatly reduces the revolving door of hospital admissions and emergency room visits.

Did you know? The period for hospital re-admission is within the first 30 days after discharge. The second most likely period is the subsequent 30 days. 

The majority of these re-admissions are avoidable if the patient had proper continuity of care. Medical house calls can prevent minor problems from becoming major issues that require re-admission.

What Does Your Transitional Care Program Include?

  • Initial evaluation (before the patient leaves the hospital):
    • Chart review / patient and family interview
    • Disease-specific management needs assessment
    • Medication reconciliation to prevent medication errors
    • Discharge tool (please print this form and have these questions answered before you are sent home from the hospital)
  • Home visit within 48 hours of discharge:
    • A medical house call to evaluate how the patient is adjusting to being home and to revise the plan of care
    • Additional education and training for patients, family, or caregiver about the condition
  • Follow-up home visits:
    • Scheduled depending on identified needs and definitive follow-up with the primary care provider
    • Care for any new issues that may arise and ongoing primary care needs

Conditions treated through our transitional care program include:

What Is a Memory Disorders Program?

A key feature of home-based primary care medical house calls is our memory disorders program. Nurse practitioner Dr. Raymond Zakhari provides special expertise in evaluating and treating age-related memory disorders that affect cognition and behavior in the geriatric population. 

Dr. Zakhari treats conditions including mild cognitive impairment, Alzheimer's disease, dementia with Lewy bodies, vascular dementia, dementia in Parkinson's disease, and fronto-temporal dementia.

Some early signs and symptoms of dementia include:

  • Decrease in levels of functioning and/or hygiene or incontinence
  • Sudden weight loss or gain and problems with eating or feeding
  • Difficulty managing appointments, medications, or finances
  • Complicated or poorly managed chronic health condition
  • Two or more hospital or ER visits within one year
  • Poor judgment, impaired thinking, or confusion
  • Skin breakdown, bedsores, or pressure ulcers
  • History of poor balance or falls
  • Changes in sleep pattern

What Does Your Memory Disorders Program Include?

Dr. Zakhari can manage the full spectrum of behavioral problems that often accompany dementia, providing a valuable resource for patients, families, and caregivers. Our memory evaluation includes a comprehensive physical and neuropsychiatric evaluation to properly diagnose and prescribe treatment.

Patients who benefit from an evaluation include those who need help deciding if their condition is due to normal aging, sensory overload, or another health problem that should be investigated. 

Patients who have already been diagnosed with a memory disorder or those who wish to plan for the future may also benefit from an evaluation. 

If you have noticed a new onset of short-term memory loss, a change in the ability to perform tasks of everyday living (finance, executive planning, shopping, cooking), unusual behaviors, or confusion, consider a confidential consultation.

Seniors living in Manhattan have never had better access to geriatric care. Please request a confidential consultation online or call us today at (917) 484-2709.

Metro Medical Direct