Objective: 1) To demonstrate the feasibility of an interdisciplinary home visit program (HVP) for advanced Parkinson’s disease (PD) providing expert, interdisciplinary care directly to homebound patients; 2) to test whether the HVP stabilizes patient quality of life despite disease progression. 

Background: As PD progresses, symptoms increase, quality of life declines, and individuals may become homebound, often losing access to neurologic care. This leads to a surge in acute healthcare utilization and excess morbidity. Improving access to expert in-home care may improve quality of life. In 2014, we launched the Edmond J. Safra Interdisciplinary Home Visit Program for Advanced PD to provide comprehensive care and outreach to homebound individuals with PD and related disorders. Here, we report on a prospective, longitudinal study of a subset of HVP participants with idiopathic PD and without significant cognitive impairment over one year. 

Methods: PD patients meeting Medicare criteria for homebound status and with MMSE >20 at Visit 1 received 4 home visits over 12 months as part of this study. Each visit entailed an evaluation by a movement disorders neurologist, social worker, and nurse, including detailed history, examination, medication reconciliation, psychosocial evaluation, and referral to in-home services. Quality of life (Neuro-QoL) was measured at Visits 1 and 4.

Results: We enrolled 27 subjects. At baseline, the subjects’ mean age is 81 years (SD 7.8); mean PD duration is 10 years; mean UPDRS total score is 65 (SD 20). Of the subjects completing Visit 4, total UPDRS increased by a mean of 12 (SD 10.7), yet quality of life improved in 7/8 Neuro-QoL domains. 

Conclusions: We identified and followed a unique cohort typically lost to clinical care and research—the elderly homebound with advanced PD. Despite the expected progression of functional and motor disability, HVP retention was high and subjects reported improved quality of life. Ongoing work includes the implementation of telehealth, inclusion of individuals with cognitive impairment, and comparison of outcomes with other advanced PD populations. Portions of this work were presented at the World Parkinson Congress 2016. 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quality-of-life-in-homebound-people-with-advanced-parkinsons-disease-feasibility-and-outcomes-of-an-interdisciplinary-home-visit-program/