For Medical Students

Attitudes

1. Awareness of reasons patients might need care in the home
2. Awareness of the importance of family or other support systems in managing  patients' care
3. Awareness of patients’ environment as potentially helpful or harmful to their health.
4. Awareness of the great heterogeneity of older persons and their homes
5. Awareness of the importance of cultural differences in patient decision-making
6. Awareness of the roles of interdisciplinary team members in home care

Knowledge

1. Which patients are appropriate for physician home visits
2. How to do a home functional assessment 
3. How to do a home safety assessment
4. Physician's role in terminal care in the home, including symptom management and grief
5. Physician's responsibilities and approach to elder abuse and neglect
6. Medication use in the homebound elderly. (Including how to make decisions based on benefit/burden, cost, availability, drug-drug and drug-disease interactions, side effects, adherence, and patient and family ability to understand and manage.)   
7. Appropriate use, availability, costs, and reimbursement sources for community services (e.g., senior centers, meal programs, adult day care, visiting nurses and other personnel, hospice, respite)
8. Reimbursement mechanisms for home care
9. The prevalence, symptoms, and referral sources for help with caregiver stress.

Skills

1. Ability to determine who is appropriate for home visits.
2. Ability to assess home environment including safety
3. Ability to communicate effectively with the patient's family and caregivers
4. Ability to assess the patient in a non-medical environment including appropriate physical exam
5. Ability to identify elder abuse or neglect and refer to adult protective services.
6. Ability to manage pain and other terminal symptoms effectively in the home
7. Ability to assess function including fall risk
8. Ability to identify caregiver stress and refer for additional help, if needed.
9. Ability to assess medication use, side effects and potential interactions.
10. Ability to prognosticate and assist patients sensitively in developing advance directives