Home care in elderly

Definition
Home care encompasses all medical and supportive
services provided in the home.
These services may include visits by physicians or
nurses; intravenous therapy; physical, speech, and
occupational therapy; social work; and home health
aide services.

Rationale for home visits

Cared at home without being transported to hospital
Difficulties with vision, mobility, and limited driving create
barriers to keeping medical appointments
Helps in understanding the patient in the context of the home
environment - provides clues and information important to
the patients overall health and well-being, such as hygiene,
nutrition, support, and potential for elder abuse
Understanding of compliance issues
Functional assessment is best evaluated in the home
environment

 Provides insight into function and safety not observed in

a clinic
Patients social situation and caregiver issues and
stresses are also more apparent and recognizable
Reduces clinic staff time of no show

Types of home visits

Illness Home Visits

- Emergency
- Acute illness
- Chronic illness
Dying Patient Home Visits

- Terminal care
- Pronouncement of death
- Grief support

Types of home visits

Assessment Home Visits
- Polypharmacy and/or multiple medical problems
- Excessive use of health care services
- Immobility, social isolation, or suspected abuse or neglect
- Recent catastrophic diagnoses or possible need for
nursing home placement
Hospitalization Follow-up Home Visits
- Acute illness, injury, or surgery

Acute skilled care

Roles of the home care team

members
The home care team may be composed of a
Physician who makes house calls and/or provides
medical direction
A house call coordinator,
Home health care nurses, and
Other health care professionals and services

House call coordinator

Point of communication
Assists with scheduling of patient visits, patient calls,
and coordinating telephone consultations between team
members
Finding aid appropriate billing
Arrangements for diagnostic testing, delivery of
medications and supplies, special clinic appointments

Home care nurses

Patient assessment
monitoring of prescribed treatment regimens including
medication administration and compliance
Wound care and diagnostic services
injections, immunizations, urinary catheterization, and
ostomy care
Patient and family education
dietary modifications

Rehabilitation therapists
Physical, occupational, speech, and respiratory therapists
Physical therapists provide instruction in strengthening and
balance exercise programs, gait assessment and training, and
home safety evaluation. In addition, they are trained in the use
of varying modalities for pain management
Occupational therapists provide assessment of patient
functional status and ability to live independently through
evaluation of activities of daily living (ADLs) and instrumental
activities of daily living (IADLs)

 Speech therapists provide training and exercises to

minimize deficits in language and swallowing function
Respiratory therapists assess and treat respiratory
disorders and review supplemental oxygen necessity

Physician house calls and palnning

economically viable
Physician may choose one half-day session per week to
perform house calls, averaging about five patients each
session
lean heavily on history-taking and physical examination
skills

Planning ahead
anticipate potential interruptions or problems during the
visit
Time en route can be a frustrating
Coordinate and plan visits and driving routes in
advance, confirming any uncertain directions or
addresses.
Divide patient visits into quadrants or clustering them
along certain routes minimizes excessive or
unnecessary driving

Planning ahead
Organization of equipment helps prevent delays and the
need for repeat visits
Organizing medical records

Issues to address on the home visit

Initial home visit requires extra time for history and
examination environment and social situation - Home
safety evaluation

 Hazards can be identified and remedied with placement

of grab bars in bathrooms or kitchens, application of
nonstick material to showers and bathtubs, and removal
of stray electrical cords or rugs