1. WEST AFRICAN COLLEGE OF PHYSICIANS (FACULTY OF FAMILY MEDICINE) HOME HEALTH CARE 2015 JOINT UPDATE COURSE/TOT DR UDO E ATKINSON NATIONAL HOSPITAL ABUJA NATIONAL HOSPITAL ABUJA

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Pretest Answers  1. b  2. d  3. c  4. d  5. e

10. 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

11. 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

12. CORE AREAS OF FAMILY MEDICINE Primary Care Health Facility Care Family Care Family Physician

13. PRIMARY CARE Primary Medical Care Primary Health Care

14. 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.)”.

15. 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.

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Who is a FAMILY PHYSICIAN? 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” FAMILY PHYSICIAN  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

24. 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

25. 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.

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

35. 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

36. 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

37. Functions of Primary Health Care delivered by Primary Care through Home Health Care  COMPREHENSIVE CARE  Biopsychosocial needs  Health promotion  Disease prevention  Wellness  Acute care  Chronic care

38. Functions of Primary Health Care delivered by Primary Care through Home Health Care cont’d  PATIENT-CENTRED CARE  Relationship based  Patient and families are the core of the care team  Whole person care respecting their peculiar needs, cultures, values and preferences

39. 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

40. 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 in-person hours  Patients preferences regarding access are respected

41. Functions of Primary Health Care delivered by Primary Care through Home HealthCare cont’d  QUALITY AND SAFETY  Application 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

42. TYPES HOME HEALTH CARE SERVICES  Home Health Care  Home Respite care  Adult Residential Daycare  Nursing Care  Palliative Care  Hospice Care

43. 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

45. 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

46. 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

47. 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

48. 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

50. 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

51. 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

52. Post test 1: Multi choice (One best answer)  Hospice care can be given a) 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

53. 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

54. 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

55. Post test 4: Multi choice (One best answer)  Benefit of home health care a) 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

56. 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

57. Post test Answers  1. e  2. c  3. c  4. d  5. e

58. THANK YOU & QUESTIONS

59. REFERENCES  1. Primary Care. Definitions from American Academy of Family Physicians AAFP. (Available from: http://www.aafp.org/x6988.xml). Cited 26/05/2015http://www.aafp.org/x6988.xml  2. Adrienne L, Jones BS, Harris-Kojetin L, Roberto V. Characteristics and use of 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 home- based primary care programs for home bound older adults. J Am Geriatr Soc. 2014 Dec; 62(12):2243-51  4. Montauk SL. Home Health Care. American Family Physician. Available from: http://www.aafp.org/ afp/981101ap/montauk.html. Cited 20/05/2015  5. Murkofsky RL, Alston K. The past, present, and future of skilled home health agency care. Clin Geriatr Med 2009; 25:1–17.

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