1. HOME CARE
Atthapol Chatareeyakul ,MD, FRCFPT
Department of Preventive and Social Medicine
Faculty of Medicine Vajira Hospital
Navamindradhiraj University

2. Question?
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3. There are many words
 Home care
 Home health care
 Home visit
 House call

4. 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

5. Ecology of Medical Care
1000 Population
Illness or injury
a month
750
Consulting MD in PC
250 a month
Admitted a month
9
Referred TC a month
51
Referred medical
center a month
White KL. NEJM 1961;265(18):885-892

6. 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”

7. 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

8. Types of Home Visits
1. Illness home visits
2. Dying patient home visits
3. Assessment home visits
4. Hospitalization follow-up home
visits

9. 1. Illness Home visit
•Emergency
•Acute illness
•Chronic illness

10. 2. Dying patient home visit
 Terminal care
 Pronouncement of
death
 Grief support

11. 3. Assessment Home visit
 Polypharmacy
 Excessive HC use
 Immobility
 Social isolation
 Suspected abuse or
neglect
 Recent catastrophic
diagnosis

12. 4. Hospitalization Follow-
up Home Visit
 Acute illness, injury or surgery
 Parents with newborn infants

13. Home Care Team
 Family physician
 Home health nurse
 Physical, occupational
and speech therapist
 Social worker
 Dentist
 Pharmacist
 Dietitian
 Psychologist
 Optometrist
 Podiatrist

14. Home care team
MD nurse SW
Bio Psycho Social

15. 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

16. Ideal home care physician
 Observant of surroundings
 Compassionate
 Experienced
 Effective communicator and educator
 Available
 Team player
 Know third party coverage

17. Suggested Equipment for
Home Visits
 Patient records and charting
material
 Sphygmomanometer
 Stethoscope
 Otoscope and ophthalmoscope
 Lubricant
 Basic wound dressing
 Nasogastric tube

18. Suggested Equipment for
Home Visits
 Urinary catheter supplies
 Thermometer
 Tongue depressors
 Urine dipsticks
 Glucometer
 Patient education materials
 Venipuncture set

19. Time in home visit
 Don’t more than 1 hour
 Don’t more than 2 times/week

20. 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

21. Home Visit Assessment :
IN HOME SSS
S safety
S spiritual health
S home health
care services
Brian K. The home visit. Am Fam Physician 1999

22. Immobility
Basic ADL
1. Bathing
2. Dressing
3. Toileting
4. Transferring
5. Continence
6. Feeding

23. Immobility
Instrumental ADL
1. Telephone
2. Shopping
3. Food preparation
4. Housekeeping
5. Laundry
6. Transportation
7. Take medications
8. Finances

24. 1. (plan)
2. (medical
management)
3. (identification of
patient’s need)
4. (continuing
patient centered care)
5. (participation and
family conference)

25. 6. (evaluation of
quality of care)
7. (risk
evaluation and health promotion)
8. (reassessment
of care plan)
9. (teamwork)

26. 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)

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

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

35. “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