Transcript HOME HEALTHCARE

WEST AFRICAN COLLEGE OF
PHYSICIANS
(FACULTY OF FAMILY MEDICINE)
HOME HEALTH CARE
2015 JOINT UPDATE COURSE/TOT
DR UDO E ATKINSON
NATIONAL HOSPITAL ABUJA
OBJECTIVES
By the end of this session, participants will do the following:

Overview of Home Health Care

Home Health Care Nigeria experience

Explain Home Health Care

Benefits of Home Health Care

Describe Home Health Care services

List the members of Home Health Care Team

Describe the skills necessary for Home Health Care

Describe the resources necessary for Home Health Care
Pretest 1: Multiple choice
(one best answer)
 Home
health care is within the purview of
a) Facility care
b) Primary
care
c) Family
care
d) Patient
centred care
e) Preventive care
Pretest 2: Multiple choice
(one best answer)
 The
following is a setting for Home Health Care
a) Nursing
home
b) Prison
c) Home
for the Handicapped
d) Home
setting for the purpose of promoting,
maintaining or restoring health
e) Home
for the internally displaced persons
Pretest 3: Multiple choice
(one best answer)
 Which
of the following group of people do not need
Home Health Care?
a) Mothers and newborns, home from the hospital after
24 hours
b) Patients of all ages who return home after surgery
c) Patients who have simple treatment requiring
medication monitoring
d) Haemophiliacs
e) Patients with chronic Kidney disease
Pretest 4: Multiple choice
(one best answer)
 Home
Health Care services include the
following except
a) Pain
management
b) Prescription management
c) Skilled
nursing
d) Medication reminders
e) Medication teaching
Pretest 5: Multiple choice
(one best answer)
 Longitudinal care
is not
a) Coordinated care
b) Ongoing monitoring
c) Comprehensive
d) Preventive care
e) Episodic
care
care
Pretest Answers
1.
b
2. d
3. c
4. d
5. e
HOME HEALTH CARE: OVERVIEW

As life expectancy increases with aging population in our society and
people become incapacitated through ill-health or injuries, home health
care will become necessary in our healthcare

And with the serious challenges facing the public health care system at
every level in this country, and the need for reduced hospital stays for
people of any age who are disabled, chronically or terminally ill, recovery
from surgery or injury, home health care will be very complementary.

Informally, caregivers at home are generally family members or friends;
formally, home health care consists of a professional health care team
working towards a common goal
HOME HEALTH CARE IN NIGERIA

MeCure home healthcare
 Medication set
up
 Medicine administration
 Wound care
 Insulin injection
 Intensive care ambulance

Florence Nightingale Care
Agency (FNCA)
 Home
based health care
 Home health check-up
 Professional personal care

Supreme homecare services Ltd
 Live-In-home
care services for
activities of daily living
 Day
homecare-daily visit basis
 Specialty
care-diabetes care, BP
checks, wound care, indwelling
catheter care
 Care
of chronically or terminally
care
 Post delivery care for mother and
baby at home
 Physiotherapy
CORE AREAS OF FAMILY MEDICINE
Primary Care
Family
Physician
Family
Care
Health
Facility
Care
PRIMARY CARE
Primary
Medical
Care
Primary
Health
Care
PRIMARY CARE

“Primary care is that care provided by physicians specifically trained for
and skilled in comprehensive first contact and continuing care for
persons with any undiagnosed sign, symptom, or health concern (the
"undifferentiated" patient) not limited by problem origin (biological,
behavioral, or social), organ system, or diagnosis”.

“Primary care includes health promotion, disease prevention, health
maintenance, counseling, patient education, diagnosis and treatment of
acute and chronic illnesses in a variety of health care settings (e.g., office,
inpatient, critical care, long-term care, home care, day care, etc.)”.
PRIMARY CARE (cont’d)

Depending on the health conditions and practice settings, and through
coordination of care, patient may be referred for secondary or tertiary care
within the health system

Family Physicians with wide breadth of knowledge in many areas of
medicine are key care givers; others include Paediatricians, General
Internists, Registered Nurses and Pharmacists etc.,

However, these other care givers, do not provide these services within the
context of comprehensive, first contact and continuing care

"Primary care" does not fully describe the activities of family physicians nor
the practice of family medicine.
PRIMARY MEDICAL CARE
Primary
Medical Care
Comprises
comprehensive care, patient-centred care,
coordinated care, accessible service and quality and
safety in the comfort of the patient’s home
These
are the Core functions of primary health
care
Delivered
through Primary Care
DEFINITION
 Home
health care is a
 formal,
 regulated
program of care,
 providing a range of skilled medical and therapeutic services to
 individuals and families
 women and men regardless of age or disease
 infants,
children and adolescents regardless of disease in the comfort of
their homes by a variety of licensed health care professionals and
caregivers
 Can
vary from being temporary to long term depending on the need of
patient
 Redefining of patient care from hospital or facility to home
DEFINITION cont’d

In-Home non-medical care (Home Care)
 Informal
non-medical care provided mostly by family
members, friends and other people who are not licensed
medical personnel (such as doctors, nurses) or licensed
caregivers
 Supportive
personal care, medication reminders,
companionship, meal preparation, laundry, housekeeping, etc.,
 The
family is the most important care provider for the patient
What are the GOALS of HOME HEALTH CARE

Improve the health and quality of life of the patient and family
through comprehensive primary medical care and nursing and
rehabilitative services

Reduce the need for hospitalization and nursing home and other
institutional placement

Provide support for the informal caregiver

Reduce emergency unit visits

Reduce hospital length of stay and the risk of hospital re-admission

Allow terminal patients to die at home in comfort if that is their wish

Enhance optimal growth and development of infants and children

To maximize the level of patient’s independence
CHARACTERISTICS OF CURRENT
HEALTHCARE SYSTEMS

Poor funding

Inadequately equipped

Expensive

Unhealthy rivalry among healthcare workers

Incessant strikes in the health sector

Activity based rather than performance

Ineffective

Inefficient

Difficult to access and to use
BENEFITS of Home Health Care












Offers uninterrupted services to patient and the family
More convenient
Encourages continuity of care
Enhances quality of life
Promotes independence despite the limitations of their medical
conditions
Maintaining individualism
Home is always associated with comfort, security and positive feeling
Home care keeps families together while providing support.
Home care can often be customized and personalized to patient needs
Helps patient become self sufficient as possible
Less expensive
As effective as care the patients get in a hospital
Who is a FAMILY PHYSICIAN?

“A FAMILY PHYSICIAN is one who takes professional responsibility
for the comprehensive care of unselected patients with undifferentiated
problems and who is committed to the person regardless of age, gender,
illness or organ systems affected in the context of the family”

A FAMILY PHYSICIAN does not treat diseases but takes care of the
whole person in a HOLISTIC manner using the BIOPSYCHOSOCIAL
approach

The scope of FAMILY PRACTICE is determined by HUMAN NEEDS
and not by diagnoses or procedures
What are the Human Resources for Home
Health Care team

FAMILY PHYSICIANS

Medical Social workers

General Internist

Speech therapists

Paediatricians

Occupational therapists

Obstetricians/
Gynaecologists

Physiotherapists

Dieticians

Nurses

Patient and family members

Mental health nurses

Dentists

Pharmacists
What are the Resources for Home Health Care
team? Cont’d

Non-Human resources
 Medical Equipment-BP Monitor,
Glucometer, ECG machine, USS,
and other diagnostics that can be done at home, etc.
 Non-Medical
equipment-bed, wheelchairs and other assistive
devices used in the home
 Sources
of Health Care financing-Out of pocket, donations etc.
What Skills does a FAMILY PHYSICIAN need
to achieve set goals in Home Health Care
 Skills
from the breadth and depth of
knowledge acquired during the residency
training programmes
 Skills
acquired through life-long learning
activities
What Skills does a FAMILY PHYSICIAN need
to achieve set goals in Home Health care

Ability to integrate current evidencebased content into every patient’s home
Psychomotor skills

Advocacy

Attitudinal Orientation

A team leader

Good communication and
interpersonal skills

Skills in generating and using data to
drive change

Meticulous attention to details

Medical information
management

Ability to develop long term healing
relationships with patients

Skills in the use of family
medicine tools

All these makes you a resource to a
defined population

Cognitive experience

Practical knowledge

What are the responsibilities of the FAMILY
PHYSICIAN in Home Health Care?

Provision of impactful Home Health Care through the knowledge of the
patient’s family and its dynamics

Scope of the Home Health Care will be determined by the patient and
family needs and not by diagnoses or procedures

Provision of integrated and accessible healthcare services through
sustained partnership with patients in the context of the family

Provision of comprehensive, continuous and coordinated care for the
patient and the family at any given stage of their life cycles

Provides promotive, preventive, curative and rehabilitative services
MEDICAL ETHICS IN HOME HEALTH CARE
 Provide competent medical
services with compassion
and show respect for the dignity and privacy of the
patient and patient’s home
 FP must
not go beyond the physical and emotional
boundaries of the doctor-patient relationship
 Be
honest and forthright with patients, families and
other professional home health care team members
MEDICAL ETHICS IN HOME HEALTH CARE
 Respect
the rights of the patients, families, colleagues
and other healing professionals and also safeguard
patients and families confidentiality

Respect the professional integrity and needs of non-physicians
and interact in appropriate manner commensurate with that
professional respect
MEDICAL ETHICS IN HOME HEALTH CARE

You may refuse to provide treatment to a patient, if in your
opinion the patient cannot be adequately evaluated in the
home setting

Decline home visit if the specific home or neighborhood is
unsafe and communicate same with the patient and
family/caregiver and arrange for an alternative approach to
care for the patient


Request payment only for services rendered
Never accept compensation in exchange for your signature
What are the roles of the Family Physician?

Identify patient/family for home healthcare
 Assess the scope of the Health needs of the patient/family using the
biopsychosocial approach
 Risk stratification
 Health risk management plan
 Define the standard of care and cost of care for patient and family
 Define patient and family roles as team members
 Ensure patients understand their roles and responsibilities in their care
plan
 Management of patient care
 Coordination of care and advocacy
 Health promotion and wellness needs
 Open and keep clinical records, visit notes and every daytime summaries
of each encounter with patient and family
Who should be considered for Home Health Care
 Patients
who are:
Recovering from illness, injury or surgery
Undergoing treatment-complex treatment
Disabled
Chronically ill
Terminally ill
Elderly adults, 65 years and over with
functional impairment
HOME HEALTHCARE SERVICES

Medical care

Volunteer care

Nursing care

Nutritional support

Physical, occupational, and/or  Medical equipment and supplies
speech therapy
 Laboratory and X-ray imaging
 Medical social services
and other diagnostics that can be
done at home
 Care from home health aides
Homemaker or attendant care  Pharmaceutical services
 Transportation
 Companionship


Medication reminders

Home-delivered meals
HOME HEALTHCARE SERVICES
(SKILLED HOME HEALTH SERVICES cont’d)

Diabetic care

Rehabilitative

Therapeutic

Geriatric care

Cardiac care

Continence management

Medication Teaching

Injections

Consultations

Wound care for pressure
sores or a surgical wound
 Patient and caregiver
education
 Intravenous or nutrition
therapy

Monitoring serious illness
and unstable health status

Post-delivery mother and
child care
Functions of Primary Health Care delivered by
Primary Care through Home Health Care

COMPREHENSIVE CARE
 Biopsychosocial
 Health
promotion
 Disease
prevention
 Wellness
 Acute
needs
care
 Chronic
care
Functions of Primary Health Care delivered by
Primary Care through Home Health Care cont’d

PATIENT-CENTRED CARE
 Relationship
 Patient
 Whole
based
and families are the core of the care team
person care respecting their peculiar needs,
cultures, values and preferences
Functions of Primary Health Care delivered by
Primary Care through Home HealthCare cont’d

COORDINATED CARE
 Coordinates
care across all spectrum of the
broader health care system
 Establishing
clear and open communications
among patients, families and other members of
the broader care team
Functions of Primary Health Care delivered by
Primary Care through Home HealthCare cont’d

ACCESSIBLE SERVICES
 Delivers
accessible services with shorter waiting
time for urgent need
 Enhances
 Patients
in-person hours
preferences regarding access are
respected
Functions of Primary Health Care delivered by
Primary Care through Home HealthCare cont’d

QUALITY AND SAFETY
 Application
 Use
of evidence-based best practices
of appropriate Family Medicine tools to guide
shared decision making with patients and families
 Responding
satisfaction
to patients’ experiences and patient
TYPES HOME HEALTH CARE SERVICES
 Home
Health Care
 Home
Respite care
 Adult
Residential Daycare
 Nursing
Care
 Palliative Care
 Hospice
Care
HOME HEALTH CARE SERVICES
 Home

Health Care
Provision of comprehensive care, patient-centred care,
coordinated care, accessible service and quality and safety
in the comfort of patient’s home

Skilled services include wound care, IV therapy, diabetic
care, catheter care, cardiac and respiratory assessment
and care, medication management and pain management
HOME HEALTH CARE SERVICES
 Home

Respite Care
These care services offer families the opportunity to
take a break from their caregiving responsibilities,
leaving their family member or loved one in the
hands of a respite giver
HOME HEALTH CARE SERVICES
 Adult
Residential DayCare
 Daytime
adult medical care services providing
professional and compassionate care to your family
member/patient to enable him or her live as
independently as possible in his or her own home.
 Provides
support, supervision and therapies while family
members or primary caregivers work
NURSING CARE

Client assessment and
health education

Intravenous therapy

Infusion therapy

Wound care

Tube feeding

Glucose monitoring

Catheter care

Injection administration

Post-surgical care

Blood draws

Pain management

Long-term care
management

Medication management

Activities of daily living

Vitals monitoring
HOME HEALTH CARE SERVICES
 Hospice

care
Physical and psychological care given to a terminally ill patients to make
the final dying period of life as pain free as possible

Prevention or relief of symptoms and support for patient and family

Hospice care is given to patients considered to be terminal or within six
months or less of death

Hospice care begins after treatment of the disease is stopped when it is
obvious that the patient will not survive the illness

Care continues into bereavement period with support provided for family
members for extended period of 13-months after death occurs
HOME HEALTH CARE SERVICES

Palliative Care

Physical and compassionate care given to patients who are
chronically or terminally ill

Care can begin at diagnosis, throughout treatment, during
follow-up and at the end of life whether it is terminal or not

Economic, emotional, social and spiritual needs

Care is given for control & relieve symptoms but does not cure
CONCLUSION
Since
Family Medicine is leading the
way in making health care more
patient-centered and family focused,
Family Physicians should take the lead
in making home health care a reality
in Nigeria
Post test 1: Multi choice
(One best answer)
Hospice
a) At
care can be given
diagnosis
b) Throughout treatment
c) During follow-up
d) Patients at end of life
e) Patients considered to be within six months of death
Post test 2: Multi choice
(One best answer)
Which
of the following is not a type
of home health care?
a) Home
health care
b) Home respite care
c) Adult day care
d) Palliative care
e) Hospice care
Post test 3: Multi choice
(One best answer)
 Functions
of Primary Health Care delivered by
Primary Care through Home HealthCare include
all except
a) Comprehensive care
b) Coordinated care
c) Continuing care
d) Accessible service
e) Quality and safety
Post test 4: Multi choice
(One best answer)
Benefit
a) Helps
of home health care
patient become self sufficient
b) Can be customized to patient needs
c) Promotes independence despite limitations of
medical conditions
d) More effective care than facility care
e) More convenient
Post test 5: Multi choice
(One best answer)
 Which
of the following is not skilled
home health care service
a)
Diabetic care
b)
Rehabilitative
c)
Therapeutic
d)
Geriatric care
e)
Tube feeding
Post test Answers
1.
e
2. c
3. c
4. d
5. e
THANK YOU
&
QUESTIONS
REFERENCES

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
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Home Health Care by Men and Women Aged 65 and over. National Health
Statistics Reports. 2012 Apr; 52

3. Stall N, Nowaczynski M, Sinha SK. Systematic Review of outcomes from homebased primary care programs for home bound older adults. J Am Geriatr Soc. 2014
Dec; 62(12):2243-51

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
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agency care. Clin Geriatr Med 2009; 25:1–17.
REFERENCES (cont’d)

6. Dwyer LL, Harris-Kojetin LD, Branden L, Shimizu IM. Redesign and operation of the
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Vital Health Stat 2010; 1(53).

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T28572. Available from: http://www.cdc.gov/nchs/icd/icd9cm.htm.

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
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
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
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
12. Eti S. Palliative Care: an evolving field in Medicine. Prim Care. 2011 Jun;38(2):159-71