IN-HOME CARE: IMPROVING CARE OUTCOMES IN OPTIMAL SETTINGS
Determining which care setting is most appropriate includes taking into account the overall well-being of patients. Home is a more comfortable, familiar setting, for starters. Also, patients aren’t exposed to dangerous antibiotic-resistant infections that may be found in hospitals. While patients with chronic conditions need regular care, that care can often be delivered at home by nurses and other healthcare professionals who coordinate with the patient’s doctor potentially using m-heath or e-health tools. Regular, reliable home care ensures changes in their condition can be caught early on and their treatment can be quickly adjusted. The result: better-managed conditions and fewer hospitalisations.
Caring for patients in the most optimal setting can also help control costs by freeing up hospital resources for acute patients.
In-home and community care has long been recognised as an effective tool for improving the sustainability of healthcare systems. Denmark created a pilot programme in 1984 focused on keeping elderly people at home as long as possible via in-home care. The programme, which ran for 25 years, became the foundation for the country’s policies on in-home health care delivery. As a result, Denmark is leading the world in shifting care from hospitals to home. More recent Danish reforms in 2007 led to the increase in the scope of in-home care, which now includes complex medical treatments like chemotherapy and dialysis. Sweden and France have also both seen significant increases in in-home care as a result of government policies. France’s policy on ageing, dedicated to allowing elderly patients to remain at home as long as possible, will result in significant increases in the numbers of home health care professionals between now and 2020, with at least 37,000 new jobs in the Ile-de-France region alone.
One of the core principles behind reorganisation of care delivery and the shift from hospital to home is patient-centricity. Patient-centric care requires healthcare systems and providers to determine the most appropriate setting for prevention, diagnosis, treatment and care. It also requires the development of strong links between hospitals and community care, so that healthcare providers can easily find and refer patients to appropriate care settings. This includes developing step-down care—a level of care between intensive care and general wards—and rehabilitation closer to home.
Ireland offers one example. Its Medically-Assisted Discharge service facilitates the transitional care patients need after an acute hospital admission by coordinating community-based care agencies. Through the use of remote devices to clinically monitor the discharged patient, the agencies can send clinical observations to care providers for assessment. And initial evidence shows that one-third of patients can remain at home, avoiding re-admission to a nursing home or hospital, thereby delivering cost-savings of up to €740 a day.
Ireland is not alone. More and more patients across Europe are receiving care in their homes, as evidenced by per capita spend on inpatient versus outpatient care produced by the OECD. The numbers reveal a rise in outpatient, community services and primary care. From 2000 to 2009, for example, outpatient care spend hit a growth rate of 7.0% in Estonia, 5.0% in Finland, 4.1% in Canada, and 1.9% in Germany versus 4.9%, 3.4%, 2.7 and 1.4% growth in inpatient care spending respectively.
While the shift of care from hospital into the community is a global trend, healthcare does not automatically gravitate towards a community setting. Effective policies, technologies, education of both patients and healthcare professionals and resources are needed to develop optimal care settings for people with chronic diseases.
EU Whitepaper, Action 3, p.22
20 Pager on the pilots, Ireland.
Royal College of Nursing, RCN Policy and International Department, “Moving Care to the community: an international perspective”, 2013, p.9
Spotlight on Prevention: When, Who and How?
Unhealthy lifestyles and lack of physical activity are key factors in the development of chronic diseases. Early prevention and diagnosis, better education, and above all collaboration among governments, patient organizations, and industry are crucial to prevent chronic diseases from arising.