Transcript Home Care

Home Care in Context
ENVIRON
FAMILY
PATIENT
DISEASE
Goals of Home Care
Goals of Home Care
• Provide ongoing care at
home for the chronically
ill or terminally ill, as well
as other persons with
disabilities through
restorative, rehabilitative
or palliative therapies.
Yu-Maglonzo, E.I. (2003) The Filipino Physician Today: A Practical Guide to
Holistic Medicine. UST Publishing House. Manila, Philippines.
Rice, Robyn. (2005) Home Care Nursing Practice: Concepts and Application.
4th ed. Elsevier Health Sciences.
Goals of Home Care
• Educate patients about
their illnesses or
disabilities to raise
awareness with the
intention of
encouraging healthpromoting behaviors.
Goals of Home Care
• Exist as a widely
accessible alternative in
the field of health care
services with
enforceable, high
quality standards.
Goals of Home Care
• Uplift the patients’
quality of life and
prepare them to
become reintegrated
back to the family,
community and social
support systems.
Goals of Home Care
• Foster positive patient
adjustment to and
coping mechanisms for
changes in lifestyle, role
and self-concept as a
result of illness,
disability or impending
death.
Rice, Robyn. (2005) Home Care Nursing Practice: Concepts and Application.
4th ed. Elsevier Health Sciences.
In Summary
• Health directed
– Promote
– Maintain
– Restore
– Minimize ill effects
Who Should Consider
Home Care?
People who are less able to care for
themselves as they get older
People with disability
People who are recovering
from an illness, surgery or a
hospital stay
People living
with a chronic
illness
People with terminal illness
Home
Care
Provider
Medical Care
Rehabilitation
Counseling
Health education
Wellness Program
Diagnosis/Therapy
Nursing Care
Spiritual Care
Support Group
Comm. Resources
Transportation
Bereavement Care
First Aid
The Comfortable Transition to Home
Made possible by…
 Therapeutic procedures
o
o
o
o
Parenteral & enteral nutrition
IV antibiotics
Blood transfusions
Renal & peritoneal dialysis
 Equipment & Modifications
o
o
o
o
o
Commode
Wheelchair
Incontinence supplies
Pressure mattresses
Hand rails & ramps
Home Care
• More people oriented
• Advances in technology
Preparations for Home Care
• Patient’s quality of life must be physician’s
prime concern
• What is physician’s diagnosis?
– Must share with patient’s family and caregivers
• Pertinent information
• Treatment plans
• Therapeutic options
Maglonzo, 2003
Preparations for Home Care
• Must assess both patient and environment
• Assess patient in terms of:
• Physical & mental condition (degree of mobility, dementia,
devise method of communication)
• Functioning of extremities (quadri, paraplegic, etc.)
• Sensory components (intact senses)
• Excretory functions (catheterization)
• Brief family and caregivers regarding assessment
Maglonzo, 2003
Preparations for Home Care
• Assessment of environment in terms of:
• Safety measures (bed rails, stairs)
• Access to bathroom, bedroom, doors
Maglonzo, 2003
The Physician
• Overall Manager:
– Develops the
plan in
cooperation with
the patient and
other team
members
– Coordinator of all
aspects of care
The Physician Should...
• Have acquired appropriate
Home Care Skills
• Have assessed the adequacy
of family caregivers and
resources
• Have knowledge of
community resources
• Have knowledge of Home
Care technology
• Be able to Integrate home
and hospital care
• Be able to lead the home
care team
Preparation for Home Care
• Assessment of both patient and home
environment
– Evaluation of physical condition
– Social factors
• Discuss the diagnosis, treatment plans, and
therapeutic objectives
• Enhance physical functioning (If hospitalized)
– Prevents unnecessary bed rest
– Encourage tolerable physical activity
Preparation for Home Care
• Make neccessary changes to home
environment (c/o caregivers)
• Ensure adequate safety measures are
available
• Train caregivers
• Promote patient independence, as much as
possible
Program/Strategies
1. Get Manpower
–
–
Home care team:
primary care physician,
nurse, therapist, social
worker and volunteers
Work together to meet
the needs of patient
and family
2. Train Staff
Trained in assessing hazards in the home, conducting functional
assessment, monitoring medications and assessing caregivers
• Individual team members then bring their specific expertise to the
rehabilitation goals:
■ Occupational therapists may take the lead in teaching
independence in activities of daily living, guiding the patient (if
improvement allows) through personal hygiene to domestic and
community activities.
■ Speech therapists deal with communication and motor
production of speech, as well as chewing and swallowing.
■ Nurses have specific expertise in bladder and bowel
function, and have a critical role in consolidating rehabilitation
gains. They spend many more hours with the patients and family
than any other team members.
Team Members
■ Social workers evaluate a patient's premorbid state within his or
her social network and society as a whole, and determine what aspects
were previously determinants of the patient's quality of life. Also have a
counseling role with the patient and next-of-kin, and link professionals in
arranging and coordinating community resources before and after
discharge.
■ A rehabilitation physician usually leads the team and works
closely with the nurses to deal with comorbidities, such as hypertension
and diabetes, and to treat or prevent secondary complications, such as
pressure areas and seizures (about 5% of patients will have a seizure in the
first year after stroke). A further important complication is post-stroke
depression, with a high incidence of more than 60% (Robinson et al, 2004)
The rehabilitation specialist also has an important role in the
pharmacological treatment of spasticity. Various pain syndromes (which
may include musculoskeletal trauma or complex regional pain syndrome)
are common after stroke and require careful medical assessment and
medical assessment and management.
Team Members
■ All team members
work together to deal
with other important
sequelae of stroke,
often ignored. These
include perceptual
impairment, reduced
attention and
awareness of body
parts or the
environment, and visual
field loss.
3. Prepare a home care program
• The home care program
includes:
– various services offered
– mechanics of
implementation
• Policies under a home
care program:
– should be set
– should include issues on
reimbursement / fees.
The Filipino Physician Today by YuMaglonzo, M.D.
4. Establish networking & linkages
• Helps people deal with
their interrelated health
and social problems.
• Achieved by:
– establishing good lines
of communication with
various agencies and
community resources
– having an awareness of
what they have to offer.
The Filipino Physician Today by YuMaglonzo
• Home Health Care (HHC), a division of Directed
Business Growth, Inc. is a health care service
provider utilizing the expertise and clinical skills
of a multidisciplinary team of medical health
professionals.
• It specializes in delivering wellness programs and
services to seniors and persons with disability in
the comfort of their homes.
• Its main branch is located at 137 Anonas Ext.,
Sikatuna Village, Quezon City 1100.
www.homehealthcare.com.ph
• We value S.E.N.I.O.R.S and our P.E.O.P.L.E
• Service (Paglilingkod)
Empowerment (Pagbibigay-Lakas)
New Ideas (Malikhain)
Integrity (Matuwid, Matapat at Makatao)
Ownership (Pag-ako sa Responsibilidad)
Respect (Paggalang sa tao )
Success (Tagumpay at Mapaunlad ang Bayan)
• Progress
Excellence
Openness
Passion
Loyalty
Efficiency
www.homehealthcare.com.ph
• Some of its programs include:
– Comprehensive Assessment of the Elderly
– Home Health Services
– Laboratory Examinations
– Home vaccination programs
– Caregiver training modules
– Purchase / rental of medical supplies and
equipment
www.homehealthcare.com.ph
HOME HEALTH SERVICES
Our network of professional health care
service providers allow us to provide you
with a wide range of medical services at the
comfort of your own homes and at your own
convenient
time.
Home Health Services
Non-Senior
Senior
Specialists
w/n QC
Php2,800
Php2,500
outside QC
Php3,000
Php2,800
w/n QC
Php2,000
Php1,800
outside QC
Php2,300
Php2,000
w/n QC
Php1,300
Php1,000
outside
Php1,500
Php1,300
Family Medicine
Nurse, PT, Nutritionist
www.homehealthcare.com.ph
CAREGIVER TRAINING MODULES
Our training modules are designed to train
family members, informal household carers,
and caregivers on the proper management of
patients. These are offered on a scheduled
basis.Training Module
Tentative Date Regular Rates
Taking Care of Lolo and Lola I
(Basic Skills for Family Carers)
April 25, 2009
Oct 21, 2009
Taking Care of Lolo and Lola II
(Advanced Skills in Caring for
the Elderly with Special Needs)
May 30, 2009
Nov 28, 2009
When dementia complicates
care
Feb 28, 2009
Aug 29, 2009
When your loved one is
depressed
Mar 21, 2009
Sept 26, 2009
Care of the terminally ill
June 27, 2009
www.homehealthcare.com.ph
Half-day
Php300
5. Implement the Program
Providers of homecare services
A. Review the medical records of the clients.
B. Consult with the client’s attending physician for any
clarification.
C. Consult experts and review recent literature about the
patient condition.
D. Ensure the client and other family members directly
involved with his care are informed about the said referred
service.
E. Schedule a visit with the client and family members to
establish rapport, assess their expectations and accomplish a
workable goal.
5. Implement the Program
Homecare services are not covered by Philippine health
insurance system.
A. Financial arrangements should be discussed with the
patient.
6. Evaluate the Program
Maximize the effectiveness of the homecare services and
minimize unnecessary expenses.
A. Frequent evaluation of care
1. monthly health management meeting
2. daily and weekly progress report and proper
documentation of services rendered.
B. Adjust plan of care accordingly.
Home Visit
• enables physicians to identify and
address many medical, psychosocial, and
family problems that might remain
hidden during clinic visits
What to do?
• BEFORE
– schedule the visit
– review medical records
– take notes, form questions, make hypotheses
– read textbooks and journals
– consult experts
– prepare home care plan
What to do?
• DURING
– prepare all necessary instruments
– establish rapport
– brief review of medical history and psychosocial
issues
– identify primary caregiver and assess capability
What to do?
• AFTER
– write the report
– make problem list and specific interventions
– schedule follow-up visits
– refer to other disciplines if needed
What to observe/look for?
•
•
•
•
dynamics of family interaction
family’s role in illness and healing of patient
living conditions
cleanliness, safety, and comfort in the home