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Home Care in Context ENVIRON FAMILY PATIENT DISEASE Goals of Home Care Goals of Home Care • Provide ongoing care at home for the chronically ill or terminally ill, as well as other persons with disabilities through restorative, rehabilitative or palliative therapies. Yu-Maglonzo, E.I. (2003) The Filipino Physician Today: A Practical Guide to Holistic Medicine. UST Publishing House. Manila, Philippines. Rice, Robyn. (2005) Home Care Nursing Practice: Concepts and Application. 4th ed. Elsevier Health Sciences. Goals of Home Care • Educate patients about their illnesses or disabilities to raise awareness with the intention of encouraging healthpromoting behaviors. Goals of Home Care • Exist as a widely accessible alternative in the field of health care services with enforceable, high quality standards. Goals of Home Care • Uplift the patients’ quality of life and prepare them to become reintegrated back to the family, community and social support systems. Goals of Home Care • Foster positive patient adjustment to and coping mechanisms for changes in lifestyle, role and self-concept as a result of illness, disability or impending death. Rice, Robyn. (2005) Home Care Nursing Practice: Concepts and Application. 4th ed. Elsevier Health Sciences. In Summary • Health directed – Promote – Maintain – Restore – Minimize ill effects Who Should Consider Home Care? People who are less able to care for themselves as they get older People with disability People who are recovering from an illness, surgery or a hospital stay People living with a chronic illness People with terminal illness Home Care Provider Medical Care Rehabilitation Counseling Health education Wellness Program Diagnosis/Therapy Nursing Care Spiritual Care Support Group Comm. Resources Transportation Bereavement Care First Aid The Comfortable Transition to Home Made possible by… Therapeutic procedures o o o o Parenteral & enteral nutrition IV antibiotics Blood transfusions Renal & peritoneal dialysis Equipment & Modifications o o o o o Commode Wheelchair Incontinence supplies Pressure mattresses Hand rails & ramps Home Care • More people oriented • Advances in technology Preparations for Home Care • Patient’s quality of life must be physician’s prime concern • What is physician’s diagnosis? – Must share with patient’s family and caregivers • Pertinent information • Treatment plans • Therapeutic options Maglonzo, 2003 Preparations for Home Care • Must assess both patient and environment • Assess patient in terms of: • Physical & mental condition (degree of mobility, dementia, devise method of communication) • Functioning of extremities (quadri, paraplegic, etc.) • Sensory components (intact senses) • Excretory functions (catheterization) • Brief family and caregivers regarding assessment Maglonzo, 2003 Preparations for Home Care • Assessment of environment in terms of: • Safety measures (bed rails, stairs) • Access to bathroom, bedroom, doors Maglonzo, 2003 The Physician • Overall Manager: – Develops the plan in cooperation with the patient and other team members – Coordinator of all aspects of care The Physician Should... • Have acquired appropriate Home Care Skills • Have assessed the adequacy of family caregivers and resources • Have knowledge of community resources • Have knowledge of Home Care technology • Be able to Integrate home and hospital care • Be able to lead the home care team Preparation for Home Care • Assessment of both patient and home environment – Evaluation of physical condition – Social factors • Discuss the diagnosis, treatment plans, and therapeutic objectives • Enhance physical functioning (If hospitalized) – Prevents unnecessary bed rest – Encourage tolerable physical activity Preparation for Home Care • Make neccessary changes to home environment (c/o caregivers) • Ensure adequate safety measures are available • Train caregivers • Promote patient independence, as much as possible Program/Strategies 1. Get Manpower – – Home care team: primary care physician, nurse, therapist, social worker and volunteers Work together to meet the needs of patient and family 2. Train Staff Trained in assessing hazards in the home, conducting functional assessment, monitoring medications and assessing caregivers • Individual team members then bring their specific expertise to the rehabilitation goals: ■ Occupational therapists may take the lead in teaching independence in activities of daily living, guiding the patient (if improvement allows) through personal hygiene to domestic and community activities. ■ Speech therapists deal with communication and motor production of speech, as well as chewing and swallowing. ■ Nurses have specific expertise in bladder and bowel function, and have a critical role in consolidating rehabilitation gains. They spend many more hours with the patients and family than any other team members. Team Members ■ Social workers evaluate a patient's premorbid state within his or her social network and society as a whole, and determine what aspects were previously determinants of the patient's quality of life. Also have a counseling role with the patient and next-of-kin, and link professionals in arranging and coordinating community resources before and after discharge. ■ A rehabilitation physician usually leads the team and works closely with the nurses to deal with comorbidities, such as hypertension and diabetes, and to treat or prevent secondary complications, such as pressure areas and seizures (about 5% of patients will have a seizure in the first year after stroke). A further important complication is post-stroke depression, with a high incidence of more than 60% (Robinson et al, 2004) The rehabilitation specialist also has an important role in the pharmacological treatment of spasticity. Various pain syndromes (which may include musculoskeletal trauma or complex regional pain syndrome) are common after stroke and require careful medical assessment and medical assessment and management. Team Members ■ All team members work together to deal with other important sequelae of stroke, often ignored. These include perceptual impairment, reduced attention and awareness of body parts or the environment, and visual field loss. 3. Prepare a home care program • The home care program includes: – various services offered – mechanics of implementation • Policies under a home care program: – should be set – should include issues on reimbursement / fees. The Filipino Physician Today by YuMaglonzo, M.D. 4. Establish networking & linkages • Helps people deal with their interrelated health and social problems. • Achieved by: – establishing good lines of communication with various agencies and community resources – having an awareness of what they have to offer. The Filipino Physician Today by YuMaglonzo • Home Health Care (HHC), a division of Directed Business Growth, Inc. is a health care service provider utilizing the expertise and clinical skills of a multidisciplinary team of medical health professionals. • It specializes in delivering wellness programs and services to seniors and persons with disability in the comfort of their homes. • Its main branch is located at 137 Anonas Ext., Sikatuna Village, Quezon City 1100. www.homehealthcare.com.ph • We value S.E.N.I.O.R.S and our P.E.O.P.L.E • Service (Paglilingkod) Empowerment (Pagbibigay-Lakas) New Ideas (Malikhain) Integrity (Matuwid, Matapat at Makatao) Ownership (Pag-ako sa Responsibilidad) Respect (Paggalang sa tao ) Success (Tagumpay at Mapaunlad ang Bayan) • Progress Excellence Openness Passion Loyalty Efficiency www.homehealthcare.com.ph • Some of its programs include: – Comprehensive Assessment of the Elderly – Home Health Services – Laboratory Examinations – Home vaccination programs – Caregiver training modules – Purchase / rental of medical supplies and equipment www.homehealthcare.com.ph HOME HEALTH SERVICES Our network of professional health care service providers allow us to provide you with a wide range of medical services at the comfort of your own homes and at your own convenient time. Home Health Services Non-Senior Senior Specialists w/n QC Php2,800 Php2,500 outside QC Php3,000 Php2,800 w/n QC Php2,000 Php1,800 outside QC Php2,300 Php2,000 w/n QC Php1,300 Php1,000 outside Php1,500 Php1,300 Family Medicine Nurse, PT, Nutritionist www.homehealthcare.com.ph CAREGIVER TRAINING MODULES Our training modules are designed to train family members, informal household carers, and caregivers on the proper management of patients. These are offered on a scheduled basis.Training Module Tentative Date Regular Rates Taking Care of Lolo and Lola I (Basic Skills for Family Carers) April 25, 2009 Oct 21, 2009 Taking Care of Lolo and Lola II (Advanced Skills in Caring for the Elderly with Special Needs) May 30, 2009 Nov 28, 2009 When dementia complicates care Feb 28, 2009 Aug 29, 2009 When your loved one is depressed Mar 21, 2009 Sept 26, 2009 Care of the terminally ill June 27, 2009 www.homehealthcare.com.ph Half-day Php300 5. Implement the Program Providers of homecare services A. Review the medical records of the clients. B. Consult with the client’s attending physician for any clarification. C. Consult experts and review recent literature about the patient condition. D. Ensure the client and other family members directly involved with his care are informed about the said referred service. E. Schedule a visit with the client and family members to establish rapport, assess their expectations and accomplish a workable goal. 5. Implement the Program Homecare services are not covered by Philippine health insurance system. A. Financial arrangements should be discussed with the patient. 6. Evaluate the Program Maximize the effectiveness of the homecare services and minimize unnecessary expenses. A. Frequent evaluation of care 1. monthly health management meeting 2. daily and weekly progress report and proper documentation of services rendered. B. Adjust plan of care accordingly. Home Visit • enables physicians to identify and address many medical, psychosocial, and family problems that might remain hidden during clinic visits What to do? • BEFORE – schedule the visit – review medical records – take notes, form questions, make hypotheses – read textbooks and journals – consult experts – prepare home care plan What to do? • DURING – prepare all necessary instruments – establish rapport – brief review of medical history and psychosocial issues – identify primary caregiver and assess capability What to do? • AFTER – write the report – make problem list and specific interventions – schedule follow-up visits – refer to other disciplines if needed What to observe/look for? • • • • dynamics of family interaction family’s role in illness and healing of patient living conditions cleanliness, safety, and comfort in the home