CHARLESTON, W.Va. -- No one wants to go to a hospital, much less stay there. Unless it's absolutely necessary, we would rather stay at home, living independently. And if we can, we should. This much we know for sure.

That's why health-care professionals still make house calls. At this very moment, right in your own community, maybe even next door, some of your neighbors are quietly receiving health-care services at home. 

Each year, some 69 home health-care organizations in West Virginia send professional caregivers -- nurses, therapists, social workers and others -- to look after an estimated 22,000 patients.

That's the good news.

Yet the value of health care at home -- the lifeline it literally represents for millions of Americans, especially the elderly, the chronically ill, the homebound -- remains little recognized, seldom appreciated and largely misunderstood.

It's still a well-kept secret. In all the recent debate over health-care reform, all too many Americans, elected officials and citizens alike, have overlooked the advantages of health-care services delivered right to your doorstep.

As a result, vast needs are still going unmet. An estimated 12 million Americans currently receive health care at home, according to the National Association for Home Care & Hospice. Yet to the best of my knowledge, no organization tracks the untold millions of patients who are no doubt either going without health care at home or getting less than clinically needed.

That's the bad news.

Consider the context. The aging of the American population is accelerating. And about three in four of Americans age 65-plus have multiple chronic conditions such as diabetes, high blood pressure and COPD.

More Americans, especially older ones, are living alone than at any time in history, too. Nearly a third of all households in the U.S. have just one resident -- a total of 31 million of us, compared to just four million in 1950. And the Baby Boomers now turning age 65 at the rate of roughly 10,000 per day may well prefer to live alone more insistently than previous generations.

If the problem here is an aging, chronically ill America, one solution is health care at home. But before we can leap ahead, we have to take a few baby steps. The medical community, including physicians, medical schools and hospital administrators, will need to better define health care at home -- exactly what it does, why it matters and how it makes a difference -- in order to make it real and bring it to life for patients and family caregivers.

For example, health care at home is widely perceived, mistakenly, to be merely custodial, almost a matter of hand-holding and baby-sitting. In fact, home health is a multi-dimensional, multi-disciplinary provider of superior post-acute clinical service. The profession is increasingly adopting an innovative new model and getting more directly involved in patient care than ever before.

Plainly put, home health-care professionals routinely manage medications (our average patient takes 12 different kinds), change bandages, clean surgical wounds, administer essential therapy -- sometimes in the form of injections and intravenous fluids -- and do so compassionately, empowering patients (ours average 81 years of age) to live with dignity.

That kind of highly focused, deeply intimate attention, one-to-one and day-by-day, yields concrete rewards. Thanks to such services, according to the Centers for Medicare and Medicaid, patients under home health care sometimes move better, eat better, breathe better, suffer less pain, and generally function better.

In the best of scenarios, those unable to walk can once again climb to the top of the stairs. The man who lost the power of speech can once again tell his wife he loves her. We receive thousands of letters from grateful patients and families telling us as much.

Big picture, evidence is mounting that health care delivered at home may enable patients to live longer lives and, equally important, better ones. It can shorten hospital length of stay and lower readmissions. In the process, it is proving to do exactly what most needs to be done -- namely, raise quality of care, improve patient outcomes and drive down costs.

As such, then, home health care is emerging as a microcosm of what the health-care system should be doing across the board. It gets us where we live. After all, true health-care reform should always start at home.

Robie practices family medicine with Nitro Primary Care. He is a regional medical director for Amedisys Home Health and Hospice.