The doctor-patient relationship in the home.

The rapid growth of the geriatric sector of the population has, in part, led to the explosion of the home care industry and the rebirth of the house call. Understanding the population being served is always the first step in providing excellent care. Older people who are frail and homebound have physical, social, and emotional needs that require careful assessment and team intervention in the home. To provide care, the practitioner must establish trust with the patient and the caregivers. Often, the agenda of the patient, family, and physician differ. A multidisciplinary team can offer help to meet the needs of each party. Allowing the patient to be an active participant in the care plan is paramount. Changes should be made slowly with careful explanation and education at each step, and the right of an individual to refuse treatment should be respected. Support for the caregiver and accessibility for consultation and advice can make a difference in the quality of care an older individual receives.