Our Services

Evidenced Based Care Plans

Diabetes

Diabetes is a multi-organ offender that targets almost every major organ.  Chronically ill patients, especially, geriatric patients with diabetes are at higher risk of frailty, cognitive impairment, urinary incontinence, traumatic falls, kidney failure, cardiovascular disease, and poly pharmacy.  MD at Home has a comprehensive diabetic management plan that includes: medication management, blood glucose management, home skilled nursing, nutrition management counseling, foot care, therapeutic shoes, and eye care.

CFH

Heart Failure is one of the most challenging chronic conditions to manage in the outpatient setting, especially in the poly-chronic, homebound patient population.  The care plan includes fluid management, ejection fraction monitoring, polypharmacy reduction, home nursing, and blood pressure control. 

COPD

COPD is a major chronic condition that impacts patients beyond their breathing difficulties affecting their quality of life.  The focus of the COPD care plan is to evaluate the patient’s pulmonary functions, eligibility and need for oxygen, properly order the necessary oxygen equipment, home nursing, and home physical therapy.

ADL/Mobility/Fall Risk

Falls are the leading cause of injury-related deaths in the elderly.   MD at Home has developed a simple and straight forward care plan to address our patients’ mobility struggles and reduce the number of fall incidents in our population.  The mobility care plan aims at evaluating the fall risk of our patients in their home by using standardized screening tools, ordering fall-preventing DME, reconciling medications, at-home nursing and physical therapy, and caregiver education.