Our Home-Based Care Policy
1.0 PREAMBLE
Health care access remains one of the barriers to achieving a healthy world population. The cost of seeking health care also remains high in many areas of the world necessitating a need for cost-effective delivery of health services. Poor health outcomes are traceable to the lack of access, poor health seeking behavior, lack of information, late diagnosis and poor management of cases. Home based care is one of the means of mitigating this.
The World Health Organization (2002) defines Home Based Care (HBC) as any form of care given to ill people in their homes, including physical, psychosocial, palliative and spiritual activities. Home based Care increases efficiency of health systems by increasing accessibility to healthcare, reducing cost of care and burden on hospitals while delivering care in convenient and familiar environments to patients. Through this model of health care, more people receive the highest quality of care with reduced barriers to healthcare.
Different health professionals, lay community health workers and home based care volunteers deliver home based care. The use of technology is an asset to the delivery of home based care. E-TIBA is keen to employ different telemedicine strategies in delivery of home based care. Telemedicine offers an avenue to achieve the
universal health coverage goal by increasing access to health care, reducing costs of care for both the patient, caregivers and healthcare workers, and helping to achieve better health outcomes. Through various technological means employed in telemedicine, early diagnosis, convenient follow-ups for patients is achieved. Telemedicine also helps to provide linkage to hospitals helping in healthcare agency-hospital collaborations, increasing health care capacity for different hospitals and reducing transportation costs for both patients, caregivers and health care workers.
2.0 PURPOSE/OBJECTIVE
To provide Home Based Care that helps people who need acute, end-of-life, rehabilitation, maintenance and long-term care to remain independent at home. Home Based Care encourages and supports assistance provided by the family and/or community and provides monitoring of low-risk patients in the home setting.
3.0 POLICY STATEMENTS
- Home care should preserve and promote volunteer involvement; ii. Service decisions in home care should be based on assessed client needs and the risk to the client if service is not provided;
iii. Individuals have the right to be treated with kindness, dignity and respect; iv. A person’s right to live at risk to one’s self and to accept or refuse services is respected;
- Home Based Care services should be provided respecting the client’s cultural values and, whenever possible, by staff who are of the client’s language and culture;
- Regional Health Authorities should have significant responsibility for planning and delivering home care services; vii. Home Based Care involves the planning and coordinating of local health and community services; and,
viii. Home Based Care does not provide services to allow caregivers to work at a long-term job. Home Based Care is not provided to relieve parents from routine childcare.
4.0 DEFINITIONS, ABBREVIATIONS AND ACRONYMS
A & E: Accident & Emergency
BP: Blood Pressure
HBC: Home Based Care
WHO: World Health Organization
DEFINITIONS OF TERMS
Guardian: Another person authorized to give informed consent or make decisions on behalf of the patient, when the patient is incompetent or otherwise unable to make decisions
Clinician: Qualified consultant, medical officer, nurse or clinical officer
5.0 RESPONSIBILITIES OF KEY ACTORS
- Home Based Care Coordinator
- Implement, manage and evaluate current operational processes and procedures in accordance with the standards and procedures set out by MOH.
- Oversee core functions including Caregiver staffing and recruitment, customer services and
Caregiver credentialing
- Assist in developing strategies and implementation plans to improve and standardize all aspects of operations
- Develop, write and implement policies and procedures of home based care
- Establish metrics for key areas of measurement within operations and hold teams accountable to achieve or exceed these goals
- Establish a climate that encourages teamwork and promotes collegial collaboration among all team members
- Consultant Physician
- Give expert medical advice when needed during patient reviews
- Provide new interventions, assess medication compliance, and recommend environmental modifications.
- Examine patients, conduct diagnostic tests, prescribe medications, and educate patients, families, and caregivers about management of chronic diseases where necessary
- Perform some procedures in the home as well as refer patients for other testing and services
III. Medical Officer/Clinical Officer
- Assess patient eligibility for home based care in liaison with a Social Worker
- Enroll patients into the home based care program c. Clerk and manage patients
- Conduct daily telemedicine consultations
- Conduct home visits when required
- Perform venipunctures and other specimen collection procedures
- Refer patients to consultant if need be
- Discharge patients from home based care
- Nursing Officer
- Educate the patient and caregiver on how to give care at home b. Educate the patient and caregiver on how to take vital signs at home
- Monitor and record patients’ daily vital signs as reported by the caregiver
- Conduct home visits when required
- Conduct nursing care at the homes of the patients when need arises
- Nutritionist
- Conducting nutrition assessment that involves acquiring client’s diet and lifestyles, evaluating dietary related laboratory values, medical-surgical history
- Provision of nutritional education and counseling. c. Offering explanations on nutritional curative and preventative measures along with individual nutrition needs-both macronutrient/micronutrients based on biochemical values, gender, physiological conditions, age and diagnosis.
- Setting up SMART nutritional goals on healthy diets and lifestyle such as body weight, Exercises, dietary habits, laboratory values including blood sugar, lipid/cholesterol, and blood pressure among others.
- Physiotherapist
- Provide physiotherapy sessions for patients at least once a week
- Assess, diagnose and provide rehabilitation of physical problems or conditions resulting from illness, injury, disability or aging
- Assist patients to develop, maintain and restore movement and functional abilities that have been impaired
- Promote wellness and health by educating patients and caregivers on exercise and movement
VII. Psychologist
- Provide counseling for patients at least once a week. b. Provide guidance and counseling services for patients, caregivers and family members if need be.
- Assess, diagnose and treat psychological, physical and behavioral problems by providing appropriate interventions and advice
- Promote personal and social wellbeing and in turn improve the patients’ quality of life
- Refer patients for psychiatric further professional review if need be.
VIII. Nurse
- Educate patients and caregivers on the appropriate cleaning and disinfection methods
- Disinfection of patients’ homes when required c. Handling waste management if need be
- Liaise with Agency staff to carry out regular home visits for patients
- Emergency Medical Services
- Provide urgent prehospital treatment, stabilization for serious illness and transportation of patients to definitive care
- Health Records Officer
- Monitoring, evaluating and maintaining health records of patients and information systems and ensuring the information is up to date on a daily basis
- Provision of weekly statistics to the HBC Committee
- Billing Officer
- Determine patient invoice by capturing services noted on patient’s charts and facilitate the delivery of effective billing services
XII. Community liaison Officer
- Communication link between the Agency (HBC) workers and the Insurance or Hospital and the households for the duration of the home based Isolation and care through performing regular home visits and supervision.
- Identify special populations such as disabled and/or the elderly people and create specific opportunities for engagement with them through the HBC staff.
- Facilitate conflict resolution with community members by addressing issues that could occur between members of the community and the patient recuperating at home.
XIII. Customer Care Representative
- Enroll patients into HBC from various departments with the aid of Nurses on the ground
- Ensure regular training to the HBC team on PR and Communication skills
- Answer any HBC related queries.
XIV. ICT Officer
- Provide overall ICT support to the HBC program. b. Help install and support all ICT hardware and software; c. Maintain and troubleshoot all network and computer related issues;
- Integrate security, physical control solutions for all confidential data and systems;
- Monitor performance and manage parameters to provide fast responses to front-end users;
- Integrate and configure computer networking for best performance;
- Troubleshoot and repair of hardware, operating systems and applications;
- Monitor and maintain computer systems and networks; i. Identify security gaps and provide relevant solutions in consultation with the Operations manager;
- Conduct electrical safety checks on computer equipment;
6.0 KEY PERFORMANCE INDICATORS (KPI)
- Number of patients recruited monthly.
- Inquiry to admission ratio.
- Client satisfaction: Filled forms on Consumer Assessment of Healthcare Providers and Systems (CAHPS).
- Number of scheduled appointments done on time: Allowable delay time 10 minutes.
7.0 PROCEDURE STEPS
7.1 Online applicant
- Patients who apply for the Home Based Care program through the E-TIBA Forms, Website and APP shall be contacted by the Customer Care Team within 1 hour of receipt of expression of interest.
7.2 Assessing feasibility of Home-Based Care 7.2.1 A Nurse or clinician shall use the Home Based Assessment Form to conduct an assessment to verify whether the residential setting is suitable for providing care to confirm if:
- The patient is stable enough to receive care at home; 2. Appropriate caregivers are available at home;
- There is a separate bedroom or isolation space where the patient can recover without sharing immediate space with others;
- Resources for access to food and other basic necessities are available;
- There is capability to adhere to precautions recommended as part of home based and care (e.g. good personal hygiene, face-mask wear, separate meals, good hand sanitation);
- Availability of a thermometer and a person able to read and record the temperature are available; and
7.3 Assessment of patients
- Patient assessment shall include at the minimum: clinical history; physical examination; taking of vital signs and diagnostic testing.
7.4 Discharge from the Home Based Care
- Discharge from the program shall be done through an online system with the patient being provided with a discharge summary.
- The patients will be requested to fill in a client satisfaction form upon discharge.
xii. Patients who complicate before the period of home care is experienced shall be advised to seek care in the nearest identified facility. An offer to continue with care after seeking medical attention shall be made to the patients. Applicable addition costs shall be considered before an offer is made to continue with care in cases where the Home Based Care is repeated.
7.5 Addressing Barriers to Care
- Common barriers to access of care include language barriers and physical barriers. These shall be identified and documented at triage, admission and at discharge.
- Provision shall be made to avail translators to address language barriers.
7.5 Monitoring and Evaluation
iii. The Home Based Care program shall be monitored by the Nurse and challenges shall be addressed immediately. If there is a need for consultation, the home based care coordinator shall advise. The challenges and barriers shall be communicated during the HBC meeting.
- The program shall be evaluated during Home Based Care meetings which shall be held once every month. Changes to this procedure can only be made during a HBC meeting.
- All documents shall be maintained in the system for ease of evaluation and monitoring.
- The committee shall be required to submit quarterly reports through the Home Based Care coordinator office to the Management.