WEST AFRICAN COLLEGE OF PHYSICIANS

(FACULTY OF FAMILY MEDICINE)

HOME HEALTH CARE2015 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 care

d) Preventive care

e) Episodic care

Pretest Answers

1. b2. d3. c4. d5. 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

Health Facility

Care

Family Care

Family Physician

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

DEFINITIONHome health care is a

formal, regulated program of care, providing a range of skilled medical and therapeutic services to individuals and familieswomen 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

caregiversCan vary from being temporary to long term depending on the need of

patientRedefining 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

General Internist

Paediatricians

Obstetricians/ Gynaecologists

Nurses

Mental health nurses

Pharmacists

Medical Social workers

Speech therapists

Occupational therapists

Physiotherapists

Dieticians

Patient and family members

Dentists

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

Cognitive experience

Practical knowledge

Psychomotor skills

Attitudinal Orientation

Good communication and interpersonal skills

Meticulous attention to details

Medical information management

Skills in the use of family medicine tools

Ability to integrate current evidence-

based content into every patient’s home

Advocacy

A team leader

Skills in generating and using data to

drive change

Ability to develop long term healing

relationships with patients

All these makes you a resource to a

defined population

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 treatmentDisabledChronically illTerminally illElderly adults, 65 years and over with

functional impairment

HOME HEALTHCARE SERVICES

Medical care Nursing care Physical, occupational, and/or

speech therapy Medical social services Care from home health aides Homemaker or attendant care Companionship Medication reminders

Volunteer care Nutritional support Medical equipment and supplies Laboratory and X-ray imaging

and other diagnostics that can be done at home

Pharmaceutical services Transportation 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 CAREBiopsychosocial needsHealth promotionDisease preventionWellnessAcute careChronic care

Functions of Primary Health Care delivered by Primary Care through Home Health Care cont’d

PATIENT-CENTRED CARERelationship basedPatient and families are the core of the care team

Whole 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 needEnhances in-person hours

Patients preferences regarding access are

respected

Functions of Primary Health Care delivered by Primary Care through Home HealthCare cont’d

QUALITY AND SAFETYApplication of evidence-based best practices

Use of appropriate Family Medicine tools to guide

shared decision making with patients and families

Responding to patients’ experiences and patient

satisfaction

TYPES HOME HEALTH CARE SERVICES

Home Health CareHome Respite careAdult Residential DaycareNursing CarePalliative CareHospice 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

Wound care Glucose monitoring Injection administration Blood draws Long-term care

management Vitals monitoring

Intravenous therapy Infusion therapy Tube feeding Catheter care Post-surgical care Pain management Medication management Activities of daily living

HOME HEALTH CARE SERVICESHospice 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

CONCLUSIONSince 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 care can be givena)At 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 of home health carea)Helps 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. e2. c3. c4. d5. e

THANK YOU&

QUESTIONS

REFERENCES

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