HOME CARE

Atthapol Chatareeyakul ,MD, FRCFPT

Department of Preventive and Social Medicine

Faculty of Medicine Vajira Hospital

Navamindradhiraj University

Question?

There are many words

Home care

Home health care

Home visit

House call

Home care

Definition

formal, regulated program of care delivered by a variety of health care professionals in the patient’s home

Montauk SL. Home health care. Am Fam Physician 1998

Ecology of Medical Care

1000

750

250

95 1

Population

Illness or injury

a month

Consulting MD in PC

a month

Admitted a month

Referred TC a month

Referred medical center a month

White KL. NEJM 1961;265(18):885-892White KL. NEJM 1961;265(18):885-892

Home care : Why?

Continuing care

“How do you do when pt. is homebound?”

Holistic care

“Home is where a family’s value are expressed”

Patient-centered care

“It’s in home that people can be themselves”

Rationale for Home Care

To promote independent living

To improved medical care through the discovery of unmet health care needs

To assess unexpected problems

To support self care and empower

Types of Home Visits

1. Illness home visits

2. Dying patient home visits

3. Assessment home visits

4. Hospitalization follow-up home visits

1. Illness Home visit

•Emergency

•Acute illness

•Chronic illness

2. Dying patient home visit

Terminal care Pronouncement of

death Grief support

3. Assessment Home visit

Polypharmacy

Excessive HC use

Immobility

Social isolation

Suspected abuse or neglect

Recent catastrophic diagnosis

4. Hospitalization Follow-up Home Visit

Acute illness, injury or surgery

Parents with newborn infants

Home Care Team

Family physician Home health nurse Physical, occupational

and speech therapist Social worker Dentist Pharmacist Dietitian Psychologist Optometrist Podiatrist

Home care team

MD nurse SW

Bio Psycho Social

Ideal home care physician

Broadly knowledgeable about pertinent medical issues

Aware of caregiver issues

Know about medical ethics and legal issues

Know about rehabilitation

Practical and flexible

Ideal home care physician

Observant of surroundings

Compassionate

Experienced

Effective communicator and educator

Available

Team player

Know third party coverage

Patient records and charting material

Sphygmomanometer

Stethoscope

Otoscope and ophthalmoscope

Lubricant

Basic wound dressing

Nasogastric tube

Suggested Equipment for Home Visits

Urinary catheter supplies

Thermometer

Tongue depressors

Urine dipsticks

Glucometer

Patient education materials

Venipuncture set

Suggested Equipment for Home Visits

Time in home visit

Don’t more than 1 hour

Don’t more than 2 times/week

Home Visit Assessment :IN HOME SSS

I immobility N nutrition H home environment O other peoples M medications E examination

Brian K. The home visit. Am Fam Physician 1999

S safety

S spiritual health

S home health

care services

Home Visit Assessment :IN HOME SSS

Brian K. The home visit. Am Fam Physician 1999

Immobility

Basic ADL

1. Bathing

2. Dressing

3. Toileting

4. Transferring

5. Continence

6. Feeding

Immobility

Instrumental ADL

1. Telephone

2. Shopping

3. Food preparation

4. Housekeeping

5. Laundry

6. Transportation

7. Take medications

8. Finances

1. (plan)

2. (medical management)

3. (identification of patient’s need)

4. (continuing patient centered care)

5. (participation and family conference)

6. (evaluation of quality of care)

7. (risk evaluation and health promotion)

8. (reassessment of care plan)

9. (teamwork)

MD’s Responsibility at Home

Rx medical problems Identify home care needs Establishment short- and long-term goals Evaluate:New; Acute; Emergency medical problems Continue care to and from all setting

(institution, home or community)

MD’s Responsibility at Home

Communicate : Patient, team and MD

Support team members

Participate home care & family conferences

Reassess care plan and outcomes

Evaluate quality of care

Document appropriate medical records

Provide 24-hour on-call

Advantages to the patients

Pt. with difficulties accessing to care

Pt. who is difficult to exam in clinic

MD can identify problems and make suggestions by seeing conditions in which pt. live

Advantages to the physician

Patients appreciation

Professional satisfaction to do a little extra for someone who needs help

Reimbursement (billing for house calls) more than same visits done in the office

Safety in home visit

A serious concern for professionals making home visit

There are certainly associated risks

Harmful incidents are rare

Seeing pts. in the clinic or the hospital is not risk-free, nor is getting to work

Danger signs

Location of home in a high-crime area

Race or sex differences between provider and household

Intoxicated pt./caregiver exhibiting aggressive behavior

Presence of people who may be criminals

recommendations

Visit dangerous area early in the day

Use alternate provider (M in place of F)

Visit in groups of 2 or more

If feel unsafe, don’t take chances

Give pt. alternative sources for care

Truly an art

For the right pts., a superior care

For physicians, financial rewards and free word of mouth marketting

For today’s complicated health care environment, comforts both pt. and physician

Intangible rewards, a return to a simpler time, when medicine was truly an art

“There is never nothing to do at patient’s home.”

McWhinney IR.

“Practical experience in visiting homes will provide more understanding in a single glance and 5-minute of listening than volumes of written questionnaires”

Cicely Williams