We live in a society where when you need medical attention the focus is to get you to hospital. Over the last few years we have, however, seen a shift in thinking with policymakers, medical schemes and the public themselves asking for treatment at home rather than in the hospital.
The trend has actually been going on for years, but the focus was more on advanced nursed-based care for a range of conditions that can be successfully managed at home at high quality. The care services so provided include aftercare following discharge from hospital for an acute or planned surgical event, the continuation of medication administered by intravenous drip at home by trained nurses according to doctors’ prescription, the transfer of a patient on permanent respiratory ventilation after a patient has been stabilised, care and rehabilitation after an acute illness such as a stroke and also care for patients with advanced life-limiting conditions such as cancer where palliative care solutions will assist and support the patient and family through this difficult time.
There are also conditions where hospitalisation is not necessarily required, although nursing care is needed for complete recovery. These include wound care, stoma care and assistance with the management of replacing and maintaining a bladder catheter.
The gradual introduction of the “Hospital at Home” initiative provides for the acute care of patients with clinical conditions like pneumonia to be treated at home. It also provides surgeons who perform operations on patients to discharge them the same day or sooner than would have been done historically to be managed at home without compromising the quality or outcome of care.
The need for hospitalisation for patients with serious conditions will always remain but for a subset of patients this option for “healing at home”, with the necessary care that can now be delivered in the comfort of their own homes, as an alternative to being treated in a hospital, has now become a realistic alternative across the spectrum of delivering of care.
Professional nurses and trained caregivers provide care at home of which the clinical outcome and patient experience is comparable to or surpass care received in a hospital. Thus, care at home that would otherwise have require hospital inpatient care, in an individual’s own home that, according to published research is equivalent or better to the care provided within a hospital.
The “hospital-at-home” alternative does not mean that you will be discharged to go home and left at your own resources. The solution needs to integrate the whole clinical team, the surgeon and nurse practitioner who will take charge once the patient arrives back at home, the physiotherapist, anaesthetist for advice on pain management, providers of assistive devices like walker, crutches and commodes when needed. The developments in the field of health technology has also contributed to the realistic implementation of the “hospital at home” alternative.
For the acutely ill patient or the patient discharged the same day or earlier from hospital, the nurse attending to the patient at home, will attach a remote monitoring device on the patient’s chest that will ensure 24-hour monitoring of the patient’s temperature, heartrate, breathing and oxygen saturation. The central control room is linked and in touch with the treating doctor and attending nurse and will alert them if any reading outside set parameters are received. As soon as your condition is stabilised, you will be discharged from “Hospital-at-home” to ”home-as-normal”.
Times are indeed a-changing and patients and their families are back to where they belong – in the centre of the team making decisions on the what, why and where of healthcare offered. As part of the core decision makers, there are a few aspects which is important to consider when making a decision to accept home-based care. The patient and his/her family have to understand the importance that “nursing” refers to both the scientific discipline of care but also the art of caring – nurse-based coordinated care is quality care. Quality home nursing services are thus not only to have a nurse or care-giver available, services that are readily available through so-called nursing or placement agencies, which act only as a resource manager and will provide the level of health worker you request.
A well-informed decision on the home-nursing services contracted will ensure that the solutions will be to the benefit of the patient and the family. Thus, the importance of your choice that ensures that the healing environment is brought to your home – the hand on the patient of a team of experts. It is therefore advisable to engage with a company specialising in providing managed home nursing services. The “managed” terminology refers to an approach that is systemic and providing the glue to bring different components of the healthcare system together to optimise the results or outcomes of care that you strive for. The managed home nursing team manages the continuity, integration and where necessary, the transition of care. It is about the patient and information about their health status that is shared with other health professionals like family practitioners, specialists, occupational therapists, physiotherapists, social workers, etc. Thus, forming a multi-disciplinary team that plans, implement, and evaluate the condition of the patient in order to ensure the adequacy of the care provided.
In conclusion, the reality of the home as place of healing is an integral component of how healthcare is delivered internationally. This alternative to hospitalisation is also an option in South Africa and certainly here to stay .
Article suppllied by Dr Martin de Villiers, a Family Physician (Specialist) at Medwell SA: Home Healthcare Specialists.