Home healthcare: Continuous care from the hospital to the home
When we talk about home healthcare, we commonly think of palliative care and respite care.

However, the rapid development of digital health tools and increasing acceptance of telemedicine, as well as the burgeoning costs of healthcare and higher demand on hospitals, have combined to trigger a shift towards discharging suitable patients early to recover and regain their independence at home.

This allows the patient to get better in familiar and comfortable surroundings, reduce their hospital bill and lower their risk of contracting a hospital- acquired infection.

Similar to the hospital, the patient’s main doctor would be the one developing the post-discharge treatment plan, while nurses and other allied health professionals would be the main personnel implementing the treatments with the patient at their home.

The availability of digital health tools enables the patient’s vital signs to be monitored remotely, while telemedicine ensures that a doctor is just a video call away in case of any medical emergency.

Procedures at home

Previously, the idea of home healthcare was limited to the efforts of informal caregivers, like relatives or domestic helpers, in assisting the patient perform activities of daily living, like bathing and eating. Dr Teh notes that with modern home healthcare, the consulting doctor decides on the post-discharge treatment plan, which works toward the goal the patient is trying to achieve. — Photos: YAP CHEE HONG/The Star

These informal caregivers are still an essential element in a patient’s care at home as they are the ones who will be with the patient most, if not all, of the time.

However, they do require some level of training in caring for the patient, which is usually provided just before the patient is discharged from the hospital.

In fact, part of medical officer Dr Ng Chin Nee’s job is to assess whether the caregivers are caring for the patient in the correct manner.

The member of a home healthcare team notes: “It’s always possible to have an informal caregiver, be it the patient’s spouse or children, but without the right medical knowledge, they may be administering care in the wrong way.

“Even things like feeding the patient and helping them turn around in bed can be dangerous if not done correctly.”

As the environment at home can be very different from the hospital, healthcare professionals like Dr Chin Nee can also come in to help evaluate the home environment and make suggestions as to what modifications may be necessary to help facilitate the patient’s movements and recovery.

The involvement of healthcare personnel in home healthcare also means that many more procedures can be done at the patient’s home.

These include intravenous (IV) infusions, wound care, ostomy care, inserting and changing catheters or feeding tubes, as well as rehabilitation therapies, alongside measuring vital signs and monitoring the patient’s condition.

Says consultant geriatrician Dr Teh Hoon Lang: “It’s important for wound dressings to be done the same way they are carried out during the hospital stay.

“So the home healthcare team can take over by receiving the necessary information from the primary consultant and continue the dressing at home until the wound is fully healed.”

She adds that the frequency of visits can vary depending on the patient’s needs.

“As the treatment plan is highly tailored, each patient would experience care personalised to their case, regardless of their prior illness,” she says.

Potential patients

Dr Teh notes that patients who develop acute illnesses go through a process called deconditioning, in which they lose their independence as a result of becoming weaker post-treatment. According to Dr Chin Nee, even simple things like feeding the patient and helping them turn around in bed can be dangerous if not done correctly, which is why training and guidance from healthcare professionals is important.

While these patients have the potential to recover to their previous independent state of living, it requires proper rehabilitation.

“With modern home healthcare, we are able to provide the patient with rehabilitation practices even after they are discharged.

“The consulting doctor decides on the treatment plan, which works toward the goal they are trying to achieve.

“If a patient needs rehabilitation in the form of physiotherapy, the treatment plan would be designed based on the level of independence we are trying to achieve, and we work on their gait balance accordingly,” she says.

Another group of patients who would benefit from home healthcare are those who are experiencing delirium.

According to Dr Teh, being in a familiar environment can allow these patients to be more emotionally stable.

In general, the elderly make up a sizable proportion of patients who currently benefit from home healthcare, as they are more prone to hospital-acquired infections, says Sunway Home Healthcare deputy general manager Dr Ng Xun Jin.

“There’s a higher risk for them in prolonged hospital stays, so being in a more familiar and comfortable home environment can help greatly in their recovery, especially for cognitive disorders like dementia,” he notes.

Postnatal care for new mothers is another potential area for home healthcare, especially for those who prefer to stay at home rather than going to a confinement centre.

This allows for a nurse to visit and examine the condition of the mother and newborn as needed.

Continuous care

While patients and their families can opt for other home healthcare providers, instead of the hospital-based home healthcare team, Dr Teh points out two factors that should be taken into consideration. The elderly currently make up the majority of patients who undergo home healthcare, says Dr Xun Jin, as they are more vulnerable to hospital-acquired infections and benefit more from recovering at home.

“There are many available options for families if they’re looking for external home healthcare providers, but the continuity of care from the attending doctor in the hospital to them providing healthcare at home is very important, as many external providers may only stop at assisting with daily living.

“Rehabilitation is important as we don’t want to miss the chance of helping the patient recover to their healthiest and most independent state,” she says.

Another factor is that an external provider is also likely to be less familiar with the patient’s condition.

“I’ve seen a case where a fracture patient was told by their orthopaedic surgeon upon discharge, not to put any force onto the fracture as it would take up to two months before it could handle any sort of weight-bearing.

“However, they went to an external physiotherapy centre, and as the centre was not well-informed of the patient’s condition, the patient stood on his fractured leg and caused the nails to migrate and cut into the bone,” she shares.

Having safety measures in place is crucial when allowing the patient to be discharged early.

Dr Xun Jin says that besides providing training to informal caregivers, it is necessary to ensure their mental and physical well-being as well.

“Informal caregivers are part of the team too, and with needing to take care of their loved ones, they can get very stressed, which is why it is important to ensure the availability of contacting emergency help when the unexpected happens.

“Telemedicine can be very beneficial by providing a helpline and call centre, especially when patients encounter the unexpected, such as a stroke or choking.”
Wellness,Healthcare,home care,hospital
Some patients can be discharged early to continue their recovery at home with the necessary medical supervision.