Mercy has expanded its home-based care program for older adults across central Oklahoma, adding staff capacity to conduct in-home visits for seniors managing chronic conditions such as diabetes, heart failure, and mobility limitations. The program is designed to reduce hospital readmissions by catching potential complications during routine home visits rather than waiting for problems to escalate into emergency situations.
Health system administrators describe the expanded program as responding to a demographic reality facing much of central Oklahoma, where a growing share of the population is aging in place rather than moving into assisted living facilities, often by personal preference or due to the limited availability and cost of institutional care options.
Bringing Clinical Oversight Into the Home
Nurses and care coordinators participating in the program conduct regular home visits, checking vital signs, reviewing medication adherence, and assessing home safety factors that might contribute to falls or other complications. Staff say these visits often reveal issues that would not necessarily surface during a standard clinic appointment, such as difficulty managing multiple medications or challenges with mobility within the home itself.
The program's structure allows care teams to catch early warning signs of complications, such as worsening heart failure symptoms, before they progress to the point of requiring hospitalization. Health system officials say this proactive monitoring approach has shown promise in reducing avoidable emergency department visits and hospital readmissions among enrolled patients.
Supporting Family Caregivers
Beyond direct clinical care, the expanded program includes support for family members who often serve as primary caregivers for aging relatives. Care coordinators provide guidance on recognizing warning signs between scheduled visits and help families navigate the broader healthcare system, including coordinating with specialists and managing prescription refills.
Health system leaders say this caregiver support component has proven valuable given how much responsibility often falls on family members with limited formal training in managing complex chronic conditions. By providing clearer guidance and a direct line to clinical staff, the program aims to reduce caregiver stress alongside improving patient outcomes.
Mercy officials say they plan to continue expanding the program's geographic reach across central Oklahoma as staffing allows, with particular attention to communities where transportation barriers make traditional clinic visits especially difficult for homebound or mobility-limited seniors.
