Home assessments in old age psychiatry

Richardson & Orrell (2002) confuse domiciliary and home assessment visits by consultants. It is important to be clear about the distinction between them.

Domiciliary visits incur additional payment and are defined as occurring at the request of the general practitioner, and normally in his/her company, to advise on the diagnosis or treatment, where the patient cannot attend hospital on medical grounds.

Home assessment visits, or community clinics, are commonly carried out by old age psychiatrists within their contracted sessions and have been shown to have some advantages in comparison with traditional out-patient clinics: they are more likely to result in the patient being seen, are more flexible and may not be more time-consuming (Reference BenbowBenbow, 1990).

When we used a detailed questionnaire to survey the workloads of old age psychiatrists, we asked about domiciliary visits, new home assessment visits and follow-up community clinic home visits (Reference Jolley and BenbowJolley & Benbow, 1997). Respondents reported all three activities. Consultant old age psychiatrists who were working with colleagues (i.e. not single-handed) spent more time on home assessment visits, saw more new patients on home visits and saw significantly more follow-up community clinic patients. Old age psychiatrists who worked alone spent more time on domiciliary visiting and saw more patients on domiciliary visits (Reference Benbow and JolleyBenbow & Jolley, 1999). For community services there are advantages in grouping consultants together for mutual support.

We agree with Richardson & Orrell (and with the National Service Framework for Older People (Department of Health, 2001)) that home care is part of mental health practice, but the emphasis of their paper appears to be on shifting assessments from the doctor to the team. Services work best when teams (including psychiatrists, nurses, social workers and others) work towards the common goal of patient care. The definition of a domiciliary visit is irrelevant when old age psychiatry community teams are properly resourced and structured.