The first visit did not go smoothly.

The patient kept bedcovers over his head and refused to make eye contact, recalled Marianthe Grammas, MD. The man had been referred to the University of Alabama Birmingham Hospital following his treatment for a gunshot wound that left him with paraplegia.

Grammas, an associate professor of medicine at UAB, was asking the man questions, but he was giving one-word responses. Instead of focusing on his recalcitrance, she assessed the reality: a white female physician trying to help a 30-year-old Black man with myriad complications requiring frequent hospitalizations and contact with the medical system.

"I had to tee him up with a lot of love and compassion," said Grammas, medical director of the  UAB House Calls program, a home visit program that serves the Birmingham area. "I said, 'Look, man, I don't care what you did or how it happened. I am going to take care of you, and I am going to take care of you like you are my brother.'" She looked around his house and continued: "You are here for a reason. You have a 6-year-old daughter who adores you, and your mom is here taking care of you."

He softened, but not without some hard demands. "He said he didn't want any males doing his wound care," Grammas said. She assured him she would do her best to accommodate that request. Male students could accompany her, she said, adding that she would secure his permission beforehand.

After about a year, Grammas recalled, the conversations got more personal, and the one-word responses have long disappeared.

"It would have been easy for me to walk away," she said. But over time, the condescension and disapproval that the man had expected from the health care system had given way to trust. Now, she said, he tells her team: "You guys are my people."

The Return of the House Call

Home visits are enjoying a resurgence — and not just pricey concierge plans and companies that work with health plans to offer home-based visits. Specific numbers of growth are elusive, but many such programs are run by a university, as is Grammas', or by a large health plans with many hospitals.

"I'm passionate about the value of home-based medical care," Grammas said. In an office setting, she said, it is "essentially me walking in saying, 'This is what I have to do' and checking off the boxes." In a home setting, patients are more comfortable asking questions, and have more time to do so, she said. The interaction can restore what Grammas calls the relational component of the practice of medicine — which can build trust — that often is lost in a healthcare setting. 

She's not alone.

Programs like UAB's, which has been running for more than 15 years, consider home visits necessary, long-term, and even permanent care for some of their patients, due to mobility issues, chronic or life-limiting medical conditions, cognitive conditions, or other needs. The clinician is an ongoing guest in the patient's home.

Medicare covers home visits if a patient meets certain  criteria, including being homebound and under the care of a physician.

Programs may have other requirements, such as residing in a specific radius from the health care program.

The challenges are immense. Getting used to the reversal is an immediate one. Many in today's population have never before experienced a home visit by a clinician.

"That is a vulnerable position to be in," said Christopher D. Nein, MD, a primary care physician at  Sentara Health, a nonprofit healthcare system with 12 hospitals in Virginia and North Carolina. Nein is the medical director for population health and leads the Sentara home-based primary care program, which provided 3500 home visit programs in 2025 and expects to provide 5000 this year. "You can tell the patient is a bit apprehensive at first. It does take a lot of trust from them," he said.

Giving up one's own primary care physician can be another challenge. At Nein's program, the patient's primary physician remains part of the team. But in other programs, including the  UCLA Medical Home Visit (MVP) Program, at the David Geffen School of Medicine, launched in 2013, patients must give up their primary care physician and accept the home visit physician as their primary clinical contact.

That change can be difficult, said Patricia F. Harris, MD, medical director of the program and clinical chief of geriatrics. She often encounters mistrust from new patients. She eases the transitionby providing a comprehensive introduction to the patient on the details of the program.

As she explains to patients, home visits allow early identification of problems, which in turn can often result in stabilizing patients at home instead of hospitalizing them. Each person gets an individualized care plan, with additional support from other healthcare providers as needed.

The one-hour initial visit provides a complete evaluation and assessment of past medical history, information about current conditions, and discussion of long-term health goals with the patient — and the family, if that is wanted.

Harris also leaves an introductory notebook with patients with details of the program. It all helps to build trust, she said.

Despite the challenges, those involved in home visit programs talk more about the rewards — and their discovery that flipping the power dynamic is a way for patients, even those previously disillusioned with the healthcare system, to regain trust.

The home visits provide continuity of care, and research suggests that brings multiple benefits. A 2021 review of 23 studies found such continuity improves quality of care and results in greater confidence in medical decision-making.

Facing Initial Skepticism, Nervousness

As Grammas' patient with the spinal cord injury shows, not everyone is immediately enthusiastic or trusting about home visits. 

Harris recalled a patient who lived in subsidized housing who was obviously nervous about the first encounter. "She might have thought we would remove her" from her housing, Harris said. When she and the medical resident with her asked about medications, who prepared her food, and whether the woman had help cleaning her home, she was hesitant to provide details.

Several calls and conversations later, after the patient relaxed and was convinced they were only there to provide medical care, Harris said she started to call her team, asking when they would be back.

A woman who had spent decades working for a lawyer needed to read every document slowly and closely, Grammas said, and she respected that.

Grammas also focuses on respect for the patients and their home. "We make sure we ask them: 'Is it OK if we sit here?'" and ask where would be convenient to place their supplies needed for the visit, she said.

As for those who worry their house isn't clean enough, Grammas tries to reassure them. "We are not here to change the way people live," she said. "We are not here to change their home environments."

At first, "I was a little bit nervous," admitted Sandra Lefcoe, 82, of Portsmouth, Virginia, who is a home-visit patient of Nein's at Sentara. That anxiety disappeared with the first encounter. "He went about his business like he would in the office, but better," said Lefcoe, who has muscular dystrophy and no longer drives.

Nein provided something valuable, she said: "He wanted me to walk through the house to see how my walking was."

That observation gave him insight into suggesting what might help her mobility, such as installing grab bars in the bathroom and the kitchen. "He made suggestions that would make it safer. I really appreciated that," Lefcoe recalled.

While some patients may struggle with giving up their previous primary care clinician, the personality and gentle manner of the visiting physician can make the difference.

Once David Moss, 72, of Hoover, Alabama, met Grammas three years ago, the transition was easy. "She is one of those people who when you first start talking, you trust her," Moss said.

Moss has muscular dystrophy, so his mobility issues made transportation to a doctor's office difficult. His wife, Jackie, 69, is a nurse and his caregiver. She is especially grateful Grammas keeps her in the loop and provides options to both when a medical question comes up. She doesn't dictate what to do, Jackie Moss said, but gives the couple options and seeks their opinions.

Goodbye, 15-Minute Timetable; Hello, Home Lab Draws

Home visits vary in length but typically exceed 15 minutes. The Sentara program allows 90 minutes total for home visits, Nein said, with 30 minutes allotted for the clinician to drive to the house and an hour for the visit itself.

He recalled one patient who told him home visits made him feel more positive about Sentara, "that the healthcare system cared about him as an individual. And that helped to build trust."

Patients often are amazed, too, at the extent of services they can receive at home, Nein added. "We are able to bring portable X-ray machines, do EKGs in the house. We can do ultrasound, lab draws, and skin procedures such as mole checks," he said.

In one survey collected at the UAB program, a family member said the best part of the home visit for his mother was the time allowed, noting it "didn't feel rushed."

Without the hectic timeline of an office visit, Grammas said, more time exists for conversation. Over the course of the home visits, she said, "they begin to understand how interested we are in them. That is another way to build trust."

As home visit patients become accustomed to the delivery model, doctors said they get more feedback. Harris said she often hears from family members: "I'm so glad you can come. We couldn't do this without you."

Other Perks

Caregivers who have been present at home visits talk about the value of having a patient, caregiver, and physician in one place, in an atmosphere where important discussions can occur.

That was the case for John Glasser, of Los Angeles, who was a caregiver to both his parents, now deceased, when they were in the UCLA program. His father, he said, "had to make some healthcare decisions, and having the family around with the doctor in the home" made that easier.

"My mom was very comfortable having Dr. Harris come visit," he said. And she was physically comfortable, he said, being able to have the visit while sitting in a comfortable, familiar chair.

The atmosphere was relaxing. "Medical protocol was completely maintained," Glasser said. "I think my parents were more open to care."

As Gratitude Grows, So Do the Programs

The Sentara program launched in 2023 with one nurse practitioner, Nein said. "Now, we are up to six nurse practitioners."

He credits word of mouth. Patients who are happy with the program talk about it with friends, and that often leads to friends asking why their Sentara doctor doesn't come to their house, Nein said.

For many home visit patients, Nein said, the unspoken message they seem to get is: "You're important enough, I come to you."

For other patients who might benefit from home visits, David Moss offered his perspective as a suggestion: "If you can't get to the doctor and have the opportunity for one to come to you, you have to try it at least. If you're in luck, you will hit the jackpot like me."

The sources in this story reported no relevant financial conflicts of interest. 

Kathleen Doheny is a freelance writer in Los Angeles.