Home health care is an economical alternative to hospitalisation

Home health care diminishes the need for re-admission to hospitals and decreases capital construction costs by releasing hospital and institutional beds, writes Anil Kumar Chillimuntha

There is a need to drive the health care sector towards innovation not only to improve its image, but also to curb the dwindling revenues of the hospitals and reduce the health care cost.

Home care may be still be futuristic, but it’s time Indian hospitals took notice of its advantages. If started as a department, there can be a brighter side to the balance sheet.

“Home care” is a simple system that encompasses a wide range of health and social services. These services are delivered at home to the recovering, disabled, chronically or terminally ill persons in need of medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living. The history of home care is very old, but it still did not take shape in India. Nursing services have been and probably will continue to be the major component of home health care. The history of home health care is, therefore, reflected in the history of home nursing services.

Home health care can be traced to the Boston Dispensary, which in 1796 provided the sick and the poor the dignity to be cared for at home rather than in the hospital. At that time, hospitals were still considered to be pest houses where the poor went to die. In 1877, the women’s branch of the New York City mission was the first establishment in the United States to hire a graduate nurse to provide nursing care for the sick in their homes. In 1885, the first voluntary agency specifically organised to provide home nursing care was founded in Buffalo, New York. Other voluntary agencies opened their doors in Boston and Philadelphia in 1886. Gradually, it grew up to thousands of home care providers.

There are many psychological benefits to the client who receives health care services at home. In comparison with an institution, the home offers

the client more privacy and more control of the environment. The client is free to maintain customary daily habits and stay up all night and sleep all day if desired. Most often, there is a friendly and interested emotional support system close at home. Professionals treating clients on an ongoing basis in the home can note signs of deterioration and quickly take steps to remedy the situation. If blood tests or X-rays are needed for diagnosis, they can be taken in the client’s home using portable machines.

From a financial viewpoint, frequently cited advantages of home healthcare are that it reduces the length of hospitalisation by making early discharge possible. It diminishes the need for re-admission to hospitals, provides a more economical alternative to institutional care, and decreases capital construction costs by releasing hospital and institutional beds.

The most important value of comprehensive home healthcare is that it fosters independence. An exception, of course, is care of the terminally ill, but even in that situation home care in familiar and comforting surrounding makes it possible for people to die less stressfully and with a greater control over their situation.

Financing home care is not difficult. Yet, in today’s medical marketplace, you need something more, something that may hold the key to your continued good health or the solution to curing whatever might be ailing you, that something is being a clientele to a good, well-managed hospital. Ask any patient and they uniformly agree that healthcare costs money, lots and lots of money. A major illness requires a couple of weeks in the hospital and is enough to flush a life’s savings right down into the hands of the doctors, hospitals, drug companies, and diagnostic services.

This being so, there are only two things keeping most of us from bankruptcy court: the good fortune of not becoming ill or injured and, second, the use of home health care that costs less than hospitalisation. Thus, home health care may be the most important need most of us face, since sooner or later we or a loved one are bound to need the services of a physician and/or a stay in the hospital. So the effects of the extension of healthcare facilities to home are a boost to the nation’s progress.

In the US, life insurance companies saw the benefit of home nursing care, and they also became involved in the home nursing field. Metropolitan Life Insurance Company was the first to offer home visiting nurse services to some of its policyholders in 1909. The idea spread to other insurance companies, such as John Hancock Insurance Company, etc. In the late 1940s, hospitals began to enter the home health care field.

The most well known hospital-based program was and still is the Montefiore Hospital Home Care in New York City which began in 1947. With liberalisation of the insurance sector (and emergence of many Indian Insurance companies with joint ventures with foreign insurance companies) there’s a great scope for financing home care in India.

(The author is respiratory therapist and management executive with Adventist Mission Hospital, Surat. He may be contacted at anilch12@rediffmail.com)