No place like home: David Elder’s post-transplant care a ‘blessing’

By Alex Osiadacz

When David Elder’s back started to hurt in the fall of 2022, he thought his recurrent spasms had returned. But when medication didn’t help like before, his doctor sent him to the ER – and soon after, he was diagnosed with multiple myeloma, a treatable but incurable form of cancer that had caused several painful breaks in his spine.

“It just hit us out of nowhere,” he says of the diagnosis. “It was shocking.”

Five months earlier, in May, his routine bloodwork had come back normal, says Marcia, his wife of 38 years.

By October, David was fighting for his life.

Twenty years earlier, he had donated a kidney to his cousin, and now cancer was attacking the remaining kidney, rendering him vulnerable.

David spent nine days at Baptist Hospital South in Jacksonville, Fla., where they rescued his kidney, but this triumph marked the beginning of his journey rather than the end.

‘Mayo is right here’

The Elders live in St. Augustine, a northeast Florida community where David has been a worship pastor at Anastasia Baptist Church for 18 years. St. Augustine is about a half hour's drive from Mayo Clinic in Florida.

“It took a little bit of a mind adjustment to realize, OK, this is cancer, and it's a serious type of cancer. But, you know, Mayo is right here, and people move from other states to be here,” David says. “It was a no-brainer to just come here and get the process started.”

The months to come would include more doctor visits, and in February David received a transplant using his own bone marrow at Mayo Clinic in Florida.

Following surgery, he was told that he was a good candidate for Mayo Clinic’s Advanced Care at Home program, which would allow him to heal at home, with Marcia by his side and a clinician just a video call away, day or night.

The Elders jumped at the chance.

Studies have shown that 90 percent of patients who receive care through Advanced Care at Home rate their satisfaction with the program as five out of five. In addition, compared to those who received hospital care, home healthcare patients had a 50 percent decrease in readmissions.

“The only time I left him was during the transplant when they wouldn’t let me in the room,” says Marcia, who provided David’s round-the-clock care at home. “What a blessing it was to be in our house.”

No place like home

With Advanced Care at Home, an initiative of Mayo Clinic Platform, patients like David can receive high-acuity care at home, thanks to modern technology and a home-services care team that visits in person at least twice daily and is available 24/7.

Advanced Care at Home teams collaborate to provide at-home care to patients in Jacksonville, Fla., Phoenix, Ariz., and northwest Wisconsin.

A patient’s physician decides if they could benefit from the program with the aid of two artificial intelligence-based algorithms that provide a “fit score” derived from historical home hospital admissions data.

Just a few hours after David’s transplant, he and Marcia learned that he was a candidate for the program. By 6:30 p.m. that same evening, they were back home. And ten minutes after they got there, the medical transport team arrived with all the supplies they needed.

David had been in the hospital for fewer than three days.

At home David could have familiar foods and drinks, watch his favorite channels, and read his own magazines and books. With more furniture at home than in the hospital, he could find a position that didn’t hurt his back as much during his waking hours. And at night, he got more and better-quality sleep without the constant beeping and frequent interruptions common in hospitals.

“It's not infrequent that patients tell me that they didn’t get a good night of sleep in the hospital, or that it’s triggered their stress and anxiety, or it’s made their pain worse, or that the bed was uncomfortable,” says Patricia Chipi, M.D., a hospital medicine physician at Mayo Clinic in Florida who works with Advanced Care at Home.

“With Advanced Care at Home, those concerns are much less. In fact, patients are typically saying, ‘I slept great last night, and I'm starting to feel so much better,’” Dr. Chipi says.

Being near loved ones, too, provides a healing balm for patients at home.

David and Marcia’s two sons and their families are based in Florida and were able to visit during his recovery. When they came over, David would position his chair with a clear line of sight to the toy corner, where their five grandkids would gather to play.

For Marcia, playing an active role in her husband’s daily care was a challenge that provided comfort, too.

“It’s so much better. … At home, there is something I can do, versus at the hospital, where I just have to sit and watch other people do,” she says.

Something old, something new

In the Mayo Clinic tradition, home healthcare harks back to the household visits that the Mayo brothers provided to patients in the past.

“It's a different way of getting better. It reflects on what we did 100 years ago, when people would heal at home,” says Michael Maniaci, M.D., chief clinical officer of Advanced Care at Home at Mayo Clinic in Florida.

While it is not a new concept, home-based care is gaining momentum today because innovative technologies are available to help clinicians provide safe, high-quality, hospital-level treatment for complex and acute cases outside the hospital.

“The secret sauce of Advanced Care at Home is the capability to take care of the sickest patients and provide safety and quality while not replicating the hospital experience,” Dr. Maniaci says. “There is something magical about being at home.”

Under the direction of Mayo Clinic physicians, Advanced Care at Home provides comprehensive services, including infusions, skilled nursing, medications, laboratory and imaging services, behavioral health, and rehabilitation services from a network of paramedics, nurses, and other support team members who ensure that the needs of the patient come first.

Advanced Care at Home also gives clinicians a unique view into patients’ lives, which provides valuable information for their care.

“When you're in their home, they feel much more comfortable. You get to see the dynamic between family members, which is helpful,” says physician assistant Jessica Denton, who was part of David’s care team. “I think you get a more honest patient this way.”

Since its launch in 2021, the program has provided care to over 700 Mayo Clinic patients as part of a strategic relationship with Medically Home, a Boston-based technology company that has helped provide care to more than 26,000 people across the U.S.

As the program’s patient numbers continue to grow, word is getting out — and patients are starting to ask whether healing at home is for them.

“Patients are really excited about it. Especially those that have been in and out of the hospital. Now that we've had the program in place for a few years, patients are asking about it more often. They're aware of the program, and they want to be a part of it. … I think that's a great thing for the patient,” says Dr. Chipi.

Looking ahead

Positive outcomes such as these point to a bright future for home-based healing.

“Virtual care and hybrid care are a large part of the future of medicine,” says Dr. Maniaci.

David Elder takes a positive view of the future, too. He will officially retire in December, and he and Marcia are currently enjoying spending time with their sixth grandchild, born in September.

His advice for anyone who receives a diagnosis like his?

“I would ask them to think about the life that is still yet to come. There could be years and years of it,” he says. “Do not be so taken by the cancer that it takes the life out of you before it takes the life from you.”

Learn more

Learn more about multiple myeloma and find a clinical trial at Mayo Clinic.

Join the Blood Cancers and Disorders Support Group on Mayo Clinic Connect, an online community moderated by Mayo Clinic for patients and caregivers.

Also, read these articles:

• "CAR-T cell researchers at Mayo Clinic optimistic about future of treating blood cancers"
• "Advances in treating multiple myeloma help extend quality of life for patients"
• "Transplant, new model of care give hope to Salvadoran mom after cancer diagnosis"
• "Multiple myeloma: New, better treatments are improving outcomes"

A version of this article was originally published on the Mayo Clinic News Network.