Home based care - a viable option for medical scheme members

As a medical consultant, Dr Odes researched the viability of step-down facilities for the Gauteng Department of Health in the '90s and subsequently worked for National Health Services in Britain for seven years.

"At the end of the day, step down facilities weren't created by either the State or the private sector," he says, "because the infrastructure for these lower level hospitals didn't really exist, and hospital beds weren't swamped by AIDS and TB patients as anticipated in the '90s."

To cater for the needs of chronically ill or severely disabled patients who have been discharged from acute care in the private sector, Dr Odes has found that home based healthcare can be a viable and cost-effective residential option for medical scheme members as opposed to placing them in residential care, step-down-facilities, hospices, or fail care.

In addition to providing nursing services when required, home based care includes the services of other carers like doctors, physiotherapists, occupational therapists, social workers, care workers and trained domestic staff.

One contact point

A core feature of the service overseas, and now in South Africa, is that a central person interacts with all the patient's doctors and service providers, arranging multi-disciplinary case conferences and needs assessment reviews.

"Home based care is used extensively and successfully in the United Kingdom," Dr Odes says. "The majority of British patients receiving home based care are, in fact, over 75, with their needs being met by a multi-disciplinary team who make regular home visits.

Funding

"Home based care is also funded and actively encouraged by managed healthcare in the United States due to its significant benefits. In addition to increasing patients' quality of life, a large American study has shown that home based care reduces disability, the frequency of acute hospital readmissions, and the overall cost of healthcare by at least 33%," he says.

Although South Africa does not currently have a viable national healthcare system, Dr Odes has calculated that home based care for SA medical scheme members is generally less expensive than residential care in a nursing home or old aged home.

"Many older people resist entering a care home. They don't want to compromise their independence, lifestyle and personal dignity by living in an institution," he says. "Residential care can also be problematic when couples are split up, with one spouse being placed in residential care, and the other in frail care."

Creating a safe and comfortable environment

Dr Odes emphasises that "Ensuring quality home based care hinges on doing a proper medical, nursing and social needs assessment and then tailor making a care plan for the patient's needs that avoids unnecessary services."

Home based care has been used successfully for patients with dementia, severe neurological problems and lung disease, intractable heart disease and terminal cancer, amongst others. Medical and practical support can also be given to younger people who have transient or ongoing disabilities, such as those discharged from acute rehabilitation hospitals and those with permanent brain injury,

The initial social and nursing needs assessment conducted by Odyssey Assist evaluates key care areas which include behaviour, thought processes, psychology, communication, nutrition, continence, skin and tissue viability, breathing, medications, and level of consciousness.

Thereafter, a medical review and falls risk assessment may be conducted, as well as physiotherapy and occupational therapy needs assessment.

In addition to medical and paramedical assistance, Odyssey Assist offers patients a companionship service, housekeeping assistance and administrative help with activities like banking, paying accounts and drawing up power of attorney forms or wills.

Having studied the physical, psychological and social effects of growing old, Dr Odes comments that elderly middle or upper class South Africans often lack family support, either due to emigration, or to their relatives having other commitments. The physical and emotional health of elderly people is also sometimes compromised when they are left in the care of untrained domestic staff.

"The objective of home based care is to create a safe and comfortable environment with quality and dependable care, creating peace of mind for both the patient and his or her entire family," he says.

Odyssey Assist's nursing services director, Anne Askew, was acting matron at the Rosebank Clinic during the 90s and previously worked for ten years for the Victorian Order of Nurses in Toronto - a service solely dedicated to home based care.

For further information, Dr Robert Odes, medical director of Odyssey Assist, can be contacted on +27 (0) 82 391 5062, or az.oc.tsissayesssydo@ofni.