Coordinated home care: the Massachusetts General Hospital experience.

The problem of post-hospital care remains a continued challenge, as many patients who no longer require expensive acute care facilities continue to occupy these beds, awaiting appropriate placement. The Massachusetts General Hospital Coordinated Home Care program, under the central administration of the Boston Visiting Nurse Association, has demonstrated that home care can be a viable, economically feasible alternative to institutionalization for carefully selected patients, when the appropriate medical and social needs can be met. Three major groups of patients have been effectively cared for: 1) patients with multi-system chronic illness; 2) patients with terminal malignancies; and 3) patients with catastrophic neurologic disease. The organization of the Coordinated Home Care program, the criteria for patient selection, and the issue of funding are reviewed. The impact of this program is examined in terms of its potential for better utilization of the Massachusetts General Hospital facilities, as well as the more appropriate coordination and use of existing health care resources in the community.