Primary Care for Homebound Adults St. Louis

When getting to an office is not realistic

For some people, a doctor’s appointment means arranging a ride that fits a wheelchair, finding someone to help on the stairs, sitting through pain and going home exhausted. For others, severe shortness of breath, weakness, dementia or an open wound makes the trip unsafe.

When that happens, appointments get cancelled. Prescriptions are renewed by phone with no exam. Problems are found late, often in an emergency room. Primary care for homebound adults in St. Louis exists to break that pattern by bringing the clinician to the person.

What homebound means, and what it does not

In everyday speech, homebound means you rarely leave the house because doing so is very hard. The word also has a specific definition for certain benefits, such as Medicare home health. In general terms, it describes a person who needs help or equipment to leave home, and for whom leaving takes considerable effort.

It does not mean never leaving. Occasional short trips, such as a medical appointment or a religious service, do not necessarily change a person’s status. Our guide on what homebound means for care at home explains more.

You do not need to settle the definition before you call.

What a home primary care visit can cover

The clinician sets the agenda for each visit. A home visit commonly involves:

Review of ongoing conditions such as diabetes, heart failure, lung disease and high blood pressure
A look at every medication bottle in the house, not only the list on file
An exam, including skin, feet and legs
Assessment of new symptoms
Orders for lab work, imaging, therapy, home health, equipment and specialist referrals

Some testing can be brought to the home when the clinician orders it, as our page on lab and imaging coordination describes. Between in-person visits, the clinician may use telehealth visits to check in.

A home visit has limits. It is not emergency care, and some tests and procedures still require a trip to a facility. When that is the case, Gateway can help with transportation arrangements.

What the first home visit is like

The first visit is mostly about getting to know you. The clinician asks about your health history, how you spend a typical day, who helps you, and what worries you most. Expect the medication bottles to come out of the cupboard, and expect questions about eating, sleeping, mood and falls.

The exam is hands-on and focused on what matters for you. It often includes listening to the heart and lungs, checking the legs and feet, and looking at skin where pressure builds up. Before leaving, the clinician explains what comes next, such as lab work, a referral or a follow-up date.

Who visits

Visiting clinicians who see patients through Gateway include physicians, nurse practitioners and nurses, matched to what you need. A podiatrist (DPM) can see you for a diabetic foot check or for assessment and care of a foot wound or ulcer. If you are not sure who fits, describe your situation when you call, and the treating practice decides.

Why homebound adults face a higher risk of wounds

Limited movement is hard on skin. Long hours in a bed or chair put pressure on the tailbone, hips and heels. Legs that hang down all day swell, and swollen skin can break open and is slow to heal.

Wounds in people who rarely go out can also be found late, because fewer people see them. A primary care clinician who examines the skin at home visits can notice changes sooner and manage the conditions that slow healing.

When a wound is already present, Gateway arranges wound care for homebound patients with partner wound clinicians. The wound clinician and the primary care clinician then work from the same information.

What Gateway arranges

Gateway coordinates in-home primary care in St. Louis and the surrounding region. We do the organizing so the visit can happen:

Taking the request from the patient, a family member, a home health nurse or a physician’s office
Keeping your current physician involved if you have one, or helping connect you with a practice that can follow you
Gathering records from hospitals, specialists and prior physicians
Scheduling the visit and confirming the details with you or your caregiver
Sending the clinician’s orders to labs, home health agencies and equipment suppliers

Clinical decisions belong to the treating clinician. Visit availability is confirmed by location and care setting.

How it works with your regular doctor

Many homebound adults still have a longtime physician. Home visits can work alongside that physician, with the visiting clinician sharing findings and the physician continuing to guide care. If the regular physician can no longer follow you, the home practice can become your main source of primary care. Either way, ask who handles refills, who answers calls after a visit and who is in charge of the overall plan.

Getting ready for the first visit

Gather all medications in one place, including over-the-counter products and supplements.
List your doctors, recent hospital stays and any home health agency involved.
Write down your top three concerns.
Decide who should be present, in person or by phone.

Our guide to what to expect from a house call visit has more detail.

Medicare and other plan questions

Medicare and other plans each have their own rules for visits at home. In general terms, Medicare and many other plans have rules for medical visits made at home, but requirements can differ by plan and by the care needed, and a program may ask for documentation. Cost sharing depends on the plan. Medicare’s home health benefit is a separate program with its own definition of homebound. Gateway does not provide home health services. Ask the treating practice and your plan before the first visit.

Primary care at home near you

Gateway arranges home visits across Greater St. Louis and the Metro East, with availability confirmed by location and care setting. These pages describe some of the places we serve:

For a broader view, see primary care at home in Greater St. Louis.

When to call sooner and when to call 911

Call the clinician’s office about a new fever, a fall, new confusion, much less eating or drinking, new or worse swelling, or a new sore or area of redness on the skin.

Call 911 for chest pain, trouble breathing, signs of a stroke such as a drooping face, arm weakness or slurred speech, heavy bleeding, or a person who cannot be woken. Gateway is not an emergency service.

How to start

Call 314-325-0126, or request care online with a name and phone number only. Patients, family members and caregivers can call directly, with or without a referral.

Common questions

Do I have to be completely unable to leave home to get primary care at home?

No. Many people who receive care at home can leave with help but find it exhausting, painful or unsafe. Whether a particular service or benefit applies depends on the treating provider, your plan and your needs. Describe your situation when you call, and we will explain what can be arranged.

Can I keep my regular doctor if I can no longer get to the office?

Often, yes. Tell us who your physician is. Gateway keeps an existing physician informed and involved, and some practices continue to direct care with help from home visits and telehealth. If your physician can no longer follow you, we can help connect you with a practice that sees patients at home.

Is a house call from a primary care clinician the same as home health?

No. Home health is nursing and therapy from an agency, ordered by a clinician for a defined period. A primary care clinician is the medical provider who examines you, makes diagnoses, manages medications and writes orders, including the order for home health. Many homebound adults have both.

My father refuses to go to appointments. Can someone see him at home?

If he agrees to be seen at home, a visit can be requested. He still has the right to say no to care. Tell us what he objects to, since the reason often shapes how the first visit should be set up.

Who should be at the home during the visit?

Ideally the patient and, if possible, the person who helps most with daily care. That person can describe changes the patient may not mention. If no one can be there in person, set up a phone call during the visit and have the medications and a list of questions ready beforehand.

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.

Primary care for homebound adults in St. Louis.