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The Importance of Home Care Rehabilitation by Dr. Rehan Rahim M.D.

The Importance of Home Care Rehabilitation

“Home nursing and rehabilitation is an absolutely essential part of the health scheme and must be recognized as such…if this service fails, then all other services will collapse.” – Dr. Marjory Warren (1950)

“Bed blockers put NHS in danger of collapse” – Telegraph, UK (2012)

“Promoting home care services and increasing home care funding (to enable faster discharge) could save millions each year and free up resources to safeguard frontline services.” – Galway Hospital, Ireland, May 2013

Dr. Marjory Warren (1897-1960) known as the “Mother of Geriatrics”, recognized that most elderly patients prefer to be treated at home and tend to recover faster in familiar surroundings.

“Whenever possible, they should be retained in (or returned to) their own homes, provided there is sufficient help for their comfort and welfare; and that home conditions are suitable.” – Dr. Marjory Warren

These concerns, stressing the need for improvement of home nursing and rehabilitation services, were raised more than 50 years ago. Today, many hospitals globally have reached a state of crisis.

Hospital care systems focus on short-term acute care. They were established to respond to the needs of a younger population. They have not been adapted to respond to the needs of an aged population. This will lead to an escalation of expenses for health services. To be convinced, the least developed services in health care institutions such as hospitals; are increasingly demanded – Palliative Care, Radiation Oncology & Cardiology.

Health services are indispensable to society but long-term care services have not evolved to the level and standards of short-term care. 70-85% of aged needs services are observation / supervision, home &/or familial assistance & personal assistance (i.e. standing, feeding, moving, bathing).

Based on the uncertainty surrounding the repercussions of an aging population, we can conclude several emerging facts that should be addressed. We should ensure that health systems are flexible. They will require foresight to anticipate and adapt to these foreseeable changes. Also, the future health for the next generation of elderly people is unknown. As a result, the importance of prevention programs for our youth is just as important for those aged above 65.

Scientific research has shown that body mass index, impaired peak expiratory flow and a prior presence of disability are risk factors significantly associated with loss of autonomy (approximately 8 years). Depression is also highly under-diagnosed and under-treated while illnesses such as osteoporosis, malnutrition and respiratory difficulty can all be prevented, delayed &/or served warnings through early detection, quitting smoking and nutrition services.

Loss of Autonomy Probability Statistics (Comparison)

  • GERMANY – 60 years & above (0.5%), between 60 & 80 years (3.5%), 80 years & above (30%)
  • UNITED KINGDOM – 65 years and above (5%), 85 years and above (25%)
  • FRANCE – 60 years and above (5%), 85 years and above (46%, *** 2/3’s are Women)

Risk Factors & Statistics

  • Scientific research shows that 80% of the disabled population complicates their health because of inactivity
  • Only 5% participate in regular physical activity
  • There is an existing shortage of qualified professionals

Possible Outcomes if Risk Factors are Not Addressed

  • An aging process marked by illness & dependence
  • Increased medical costs associated with maintaining health
  • An existing infrastructure that is neither sufficient nor equipped to handle these cases

Health care systems are not as simple as they used to be. Investing in the latest technology and providing patients recourse to more expensive services while facing an increasing patient load (to manage) will have more of an impact on expenses than demographic changes.

Many patients stuck in acute hospital care wards do not require hospitalized care. What they do need, is to continue their convalescence via on-going care programs. When new patients cannot be admitted or treated for acute care (or otherwise) due to a lack of bed space, the impact of “bed-blocking” can negatively affect health care systems in multiple ways.

Benefits

  • Home Care Rehabilitation services can help reduce the number of hospital admissions for chronically ill and bedridden patients
  • In addition, these services can also help reduce the number of hospital admissions for patients with musculoskeletal pain & disorders
  • Furthermore, there is also a cost savings related to sending patients abroad for post-operative rehabilitation (if services are available locally)
  • Lastly, the cost savings to health care institutions and governments (where applicable), is undeniable

Programs like these were designed to assist hospital institutions to deliver better patient-centered care while increasing capacity and availability for acute care (i.e. patients on a waiting list) without any further capital cost. Studies have shown and proven there are significant savings to Government health care budgets (where applicable). Furthermore, this allows educated & trained personnel to efficiently treat acute care patients. This method is a cost effective management tool for hospital resources.

As an example, all major hospitals and government institutions in Canada have adopted this strategy to effectively utilize resources without additional outlay of capital.

Step-down institutions are an accepted way to bring patients closer to home and accelerate the recovery period. Home Care provides an extra layer of care for slow healers and chronic patients needing help at home. Recovery in the comfort of your own home and with family is always preferred. Families can provide care for other patient needs that institutions cannot.

“Family is and will remain the first line of care for the Nation.” – Minister of Social Affairs, Germany (1999)

In Southern Europe, most people are of the opinion that families should be responsible for care. In France, there is constant debate that the state is too involved and that families should be more responsible. In Denmark, state care programs are normal and accepted. In North America, people like to keep their family at home as long as possible. However, there are options for families to choose providers of private health care services.

For many patients, especially the elderly, hospitalization results in functional decline despite cure and repair of conditions for which they were originally admitted. Hospitalization can result in a cascade of complications unrelated to the problem that caused admission, in spite of treatment. Hospitalized bed-rest superimposes factors such as enforced immobilization, reduction in plasma volume, accelerated bone loss in addition to decline of muscle strength, aerobic capacity and sensory deprivation. These factors may thrust susceptible and vulnerable people into a state of irreversible functional decline. The longer these patients stay in hospitals, the more they are prone to infections and complications.

In many disabling conditions such as stroke, it is important for rehabilitation to begin as soon as the patient is medically stable. In joint surgeries such as knee and hip replacement, it is essential that rehabilitation begins the very next day, after surgery.

While initial rehabilitation is performed in the hospital, patients have the choice to continue as an Out-Patient or Home Care. For many patients as well as their relatives, transferring the patient to a vehicle, transporting them to and from hospital locations; can be extremely exhausting and prone to accidents. Many patients post-stroke or post-surgery discontinue rehab resulting in further complications. Therefore, Home Care Rehabilitation is very relevant as a support system for maintaining health and compliments intensive rehabilitation in hospitals or rehabilitation centers.

Home Rehabilitation helps a rehab team and the patient focus on his/her own recovery, pace and goals. An interdisciplinary rehab team generally involves doctors, physiotherapists, occupational therapists, speech pathologists, nurses, social workers, family and the patient themselves. Through participation in home rehabilitation, dedicated teams can gain knowledge, specific to the patient and home environments. Rehabilitation is of more value to patients who have the capacity to perform desired activities at home in addition to those with problems related to transferring activities, functions and daily routines. Monitoring a patient with the help of relatives, in their own home environment, provides a unique opportunity to incorporate a patient’s past life while including relatives in the home rehabilitation training sequences. This increases the relevance of the rehab and encourages the patient to focus on personal goals and desires for the future.

To induce a shift in focus - from illness to action, these activities should be encouraged to help people rediscover life and recover faster. Home Care Rehabilitation provides hope, pain relief and tools to regain lost health.

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