Developing useful work opportunities for the homebound patient.

Abstract

BECAUSE the job serves many functions for the individual in addition to the obvious one of producing income, the desire to work often persists tenaciously in the face of long-term illness. While most communities provide rehabilitation services for patients who can be expected to return to industry, such services rarely are available for patients who are permanently confined to home. The experience of Montefiore Hospital in an experimental homework program, Jobs for the Homebound, indicates that it is practical to provide work for homebound chronically ill patients as part of a medical home care program. The Montefiore Home Care Program provides medical treatment at home to approximately 80 medically indigent patients with all types of chronic diseases. The severity of illness among home care patients is such that the majority would be in hospitals, nursing homes, or other institutions were it not for home care. Typical home care patients include cardiacs in chronic congestive failure, cancer patients who are pursuing a downhill course, patients with rheumatoid arthritis, and severe residuals from strokes requiring continued physical therapy. Home care patients are treated by a team composed of physicians, social workers, nurses, physical therapists, and recreation therapists. The impetus for Jobs for the Homebound was the expressed desire for work on the part -of certain home care patients and the lack of vocational rehabilitation facilities in the community for homebound patients with marginal productive capacities. The objectives of the project are to explore the vocational potential of home care patients, to develop methods for and to determine the cost of providing them with vocational rehabilitation services, and to study the impact of work on patients. Jobs for the Homebound is operated as an integral part of the home care program, adding vocational rehabilitation to the treatment program of appropriate patients. The five-year project has completed four years and five months of operation.* The first two and one-half years of project experience and preliminary findings on the impact of work are reported elsewhere.2 This paper will discuss the project findings which are most pertinent to the develop-