This Doctor Will See You at Home

For many people, an in-person visit with their primary care provider involves traveling, sometimes for long distances, to a clinic or office. But for Kevin Costello, MD’s patients, appointments mean settling into a chair in their living room or kitchen.

Dr. Costello is one of a small number of primary care physicians in the Capital Region who care for patients in their homes.

For his dedication, he was recently honored with the Award for Clinical Excellence from the New York Chapter of the American College of Physicians, who cited him as “an exemplary internist, a clinical role model, a physician we would all want for our parents, and ultimately ourselves, and a clinician who has delivered care under the most challenging conditions ranging from medical field deployments in Operation Iraqi Freedom to the care of vulnerable homebound adults.”

The Genesis of a Home Care Physician

Fellowship trained in geriatric medicine, Dr. Costello was seeing patients full-time at Albany Medical Center’s Internal Medicine Group in the 1990s when he began doing some home visits after hours.

“I ended up with about 30 people that I followed at home either fully or situationally, and that’s when I first started routinely giving my patients my cell phone number to communicate with me directly,” he said.

By 2004, he was seeing all but a few patients solely in their homes.

Now Dr. Costello, who specializes in the daily management and continuity of care for older patients, sees more than 150 patients in their homes. In a typical week, he drives as many as 300 miles across an 11-county area.

His day often begins around 7 a.m. with administrative tasks and phone calls to patients, caregivers, and agencies, and ends long after his last in-person appointment twelve hours later. He also makes time for patient appointments on Saturdays and, when necessary, Sundays.

Megan Gerber, MD, chief of Albany Medical Center’s Division of General Internal Medicine, noted that Dr. Costello’s patients are medically complex homebound older adults who live in areas that have a shortage of outpatient geriatricians and primary care physicians. “Many of his patients have avoided routine care due to the burden of travel or fear of medical facilities,” she explained.

Many more people, referred by other home care providers, family members of current patients, and Albany Med Health System colleagues, are on a wait list for a first appointment with Dr. Costello. “The demand has really exploded since the pandemic,” he said.

Collaborating with Visiting Nurses to Fill a Need

According to Dr. Costello, he and the “tiny number” of other home care primary care physicians in the region don’t have the ability to meet the demand for their services.

One way he works to help fill this need is by collaborating with other home care providers, including the Albany Med Health System Visiting Nurses.

Visiting Nurses Home Health provides a wide range of referral-based skilled nursing services in the home, including wound care, pulmonary care, diabetes management, rehabilitation, and transition assistance.

Visiting Nurses Home Care, which doesn’t require a referral, offers personal care services in the home, including assistance with bathing, toileting, dressing, housekeeping, and meal preparation. In addition, home health aides are available to assist with colostomy care and temperature and blood pressure monitoring.

Training the Next Generation of Home Care Providers

 Dr. Costello’s patients know that when he pulls up to their house, he’s bringing his rolling “office” with him. But his car is also a beloved classroom.

On most days, at least one medical, pharmacy, or nurse anesthetist student, or a fellow from Albany Medical College’s Geriatric Medicine program, accompanies him to his patient appointments.

“Patients and families have been generally quite receptive of the extra minds,” said Dr. Costello, adding that home care is, “an amazing teaching venue for interprofessional learning.”

Ultimately, Dr. Costello hopes that Visiting Nurses, Albany Medical College, and other local institutions can establish a home care training program in the region.

“The entire home care work force needs reconstitution and growth following the ravages of the pandemic, and it needs very much to be a collaborative, team endeavor,” he said.