A creative disruption transforming healthcare to manage the evolving challenges for the continued delivery of patient-centric, quality care cost-effectively.
The scene of healthcare is probably the most dynamic and challenging that must be engineered and tuned to address the challenges all nations and individuals face. The challenges are many; the fast progression of the ageing population and cost of health care, the advancing technology and treatments, the globalization of medicine, and the many exciting discoveries in medicine, drugs and care delivery. All of these comes attached with an ever-increasing cost that surpasses the growth of a nation’s GDP and individuals per capita income.
All nations face this dilemma on how to address this complex situation to continuously improve the delivery of quality health care for all equitably. Then we have the evolving situation in the family sphere, changing from an extended family model to more independent living. Coupled with the ageing population, the mobility of family members and many single-parent families where the family support has become a privilege rather than a norm. We in Malaysia are not alien to this evolving trend.
The good thing is that the practice of medicine is also evolving and adapting to this changing situation, becoming more quantitative in every stage of the practice of medicine. Technology is an enabler of this change, and we must keep pace with this exciting development to harness its benefits. There must be a real tangible benefit that should evolve to circumvent these challenges in healthcare.
New medical devices and technology help to keep patients at home rather than in costly institutions, potentially good savings and encumbrances for the patient and family. Home health care is here to stay and expand. And home health care is not only for the elderly, but it encompasses post-hospitalisation care, especially after a procedure or surgery that requires continued nursing care to recuperate and regain independence.
DidYouKnow>>>> Home health care is not only for the elderly, but is also for post-hospitalisation care, post-natal care and specialised nursing care.
Professional home health care is an enabler of continued management of care in the home setting. Specific home care packages include post-maternity care for the mother and baby, palliative care, physiotherapy services, doctor home visit consultation, for specialised nursing procedures or therapy like home dialysis, diabetic management, wound care and dressing, administering injections and colostomy care.
The transformation of acute illness, e.g. heart failure into chronic diseases and the increasing prevalence of non-communicable diseases means the number of patients is growing. The statistic shows the number of all hospital beds in the United States from 1975 to 2015 decreased from 1,465,828 hospital beds to under 900 thousand in 2015, constantly decreasing in the last decade. Medical care is delivered in clinics and home settings, in some cases to make way for new ambulatory-care centres which are of lower-cost and a more accessible alternative. New technology and better drugs are allowing more patients to receive treatment outside of hospitals.
Home health care is a growing sector in developed countries. Home care enables the patient to receive continuity of care to recover from surgery or a chronic condition. It also relieves the patient and the family from many challenges in seeking care from a facility when the care can professionally be administered at home.
It has matured in growth in the last 10 to 15 years and is picking speed with technology and mobile communication. The biggest challenge is labour (mainly nurses and caregivers) which accounts for more than two-thirds of the expenditure.
Home health care relieves the patient and the family from many challenges in seeking care from a facility when the care can professionally be administered at home.
Why home health care
The term “home health care” (HHC) is defined differently across countries and regions. Home health care can be considered services provided by professionals in the home environment. However, the very first impression of the public towards HHC is taking care of the elderly. Usually, the elderly and the retired who cannot take care of themselves independently need some help at home from very basic assistance to more complex management of their care. The HHC nursing services have been around for decades.
HHC offers series of professional support services to meet the needs of each patient to regain independence and have a healthy lifestyle from home. The care can be personalised based on the individual needs and can encompass continuous care without interrupting the patient’s daily living, avoiding the high cost and discomfort stay in the hospital. Each patient’s care plan shall be arranged according to their needs in the home base setting to ensure the patient’s speedy recovery. The added advantage is being at home in their comfort zone with family members and with familiar daily living.
Depending on the individual needs of the patient, the services are rendered by either experienced registered nurse who possesses the required knowledge and skills or a caregiver for patients who need basic care. For some chronically ill patients, they may require a doctor’s home visit for review and follow-up consultation.
The advancement in digital technology, telecommunications, social networking and the internet has added valuable support in the delivery of home health care. The technology enables us to be connected seamlessly on the same platform with the patients, their family and care providers. Thus, enhancing on patient-centred care where the patient’s condition can be monitored regularly or continuously with the connected care devices.
Home health care complements the treatment at the hospital by providing continuous care after the patient is discharged. This post-hospitalisation care is necessary for some of the inpatients, especially maternity, stroke recovery and surgical patients. It augurs well for step-down care which requires more nursing care, which is being planned and monitored by the doctor who had treated the patient in the hospital. Now the doctor can keep tap of the patient’s progress after discharge, and it bridges the gap aiding continuous healing under professional care.
DidYouKnow>>>> Home health care complements the treatment at the hospital by providing continuous care after the patient is discharged.
Overall, home health care benefits the patients in reducing the duration of stay in the hospital and continue to receive skilled nursing care in their homes. The services can offer high-quality satisfaction for the patients and family members. It is more intensive nursing care one-to-one delivered by qualified nurses or caregivers following standard operating procedures and with the supervision of nurse supervisors and/or physicians.
The objective is to assist and support the patient to regain independence wherever possible while maintaining optimum quality lifestyle and activities of their daily living.
Providing care and treatment at home comes with its challenges, especially when the caregiver is under close observation by family members. At times communication with different family members of differing opinion and expectations can be overwhelming for the caregiver/nurse vis-à-vis the interest of the patient. However, the real benefit is for the patient who receives one-to-one care and attention from the caregiver/nurse.
Technology-enabled home care
Technology plays a central role in the expansion of home health care. Sophisticated technology and capabilities like the apps for mobile health, nurse on-call systems, telemedicine and internet-enabled home monitoring devices is transforming the home care delivery and efficiency. The potential for transforming healthcare and to help create positive outcomes for patients is here now. The opportunity is in the technology and the connectivity infrastructure available for healthcare providers. They need to deploy the network infrastructure and tools for their caregivers and the patient and family, to build an optimised care pathway for the patient’s healthcare journey. One that is digital, security-enhanced, connected and mobile.
Interview with Click2Health
Click2Health provides home health care services in Malaysia, and it was an opportunity to dwell deeper into its home health care services, especially in the Malaysian context and have a better understanding of the industry and how it is being managed. We interviewed Ms Lim Siew Pei, the Chief Operating Officer of Click2Health.
InfoMed: What is the value of home health care that can contribute to society?
C2H: Home health care is getting popular to optimise the outcomes of the overall care, both medical and non-medical care the patient receives. It addresses too the social determinants of health which are predominant in affecting healthcare outcomes. Identifying and addressing the patient’s social needs in parallel with addressing their medical needs means quicker discharge from a hospital stay and reduces hospital readmission rates.
Home care addresses the social and behavioural needs of the patients and the expectation of the family members and community. It is able to complete the health journey across the continuum of care reducing healthcare expenditure and improve health outcomes. Especially for patients who require continuous care at home, post-discharge. And for families who need the professional support to continue looking after their elderly parent who is dependent or requires regular specialised nursing care. Home care synchronises and coordinates care across the hospital and the community, assisting families who need professional care at home.
InfoMed: Please explain C2H differentiating service advantage?
C2H: Click2Health started its professional home health care services in November 2017. Our team of professionals include registered nurses, certified caregiver, doctors, physiotherapists, dietician, and other care team professionals. We collaborate with the professionals in planning to provide the comprehensive care. We ensure that every patient who is referred is professionally accessed for the care needed and advised by our nurse manager and supervisors. A detail care plan is developed, and the family is advised accordingly. This is to ensure proper care will be delivered and the patient is closely monitored by the team members for early detection of any abnormalities. Besides that, every case is monitored closely on the recovery progress by our senior nurse and the nursing care plan is reviewed weekly based on patient’s progress.
InfoMed: How do you see the future for home health care services?
Financially: The cost of inpatient care is increasing yearly, and longer length-of-stay in hospitals is not beneficial for the patient and cost-effective for the hospital. Faster discharge and continued professional care at home augurs well financially for all parties and offers better patient experience.
Mentally: Patients find it is more comfortable to stay at home and with the family support it will significantly improve their recovery speed. Besides, it is more convenient and reduces the burden for family members. It not only saves the overall cost of care but the time travelling to the hospital.
InfoMed: The prospect for home health care services in Malaysia?
C2H: Home health care has been well established in the developed countries for many years. The accelerating demographic changes in both the ageing population and disease pattern is fundamentally altering the underlying foundations of healthcare delivery in the future. Malaysia too is in the same situation facing this disruption and needs to be assertive in managing this change as it develops. Home health care got to be developed and managed professionally as an important service in Malaysia.
InfoMed: How does home health care complement inpatient care in hospitals?
C2H: Patients fit for discharge but require continued nursing care can be managed by the home care team. This, in turn, complements the hospital, relieving its inpatient beds to admit patients who need acute patient care and treatment. Moreover, reducing the duration of stay in the hospital will reduce the potential risk of hospital-acquired infection (HAI).
Hospitals try their best to reduce readmission, and the professional management of home care should significantly reduce the chances of any complication and readmission. In our model of care, the patient’s condition at home will be updated to the referred doctor with the consent of the family members promoting the concept of continuous care.
InfoMed: Who provides the service at home?
C2H: Our home care is managed by a team of professionals which includes registered nurses, certified caregivers, physiotherapists, dietician and doctors. Allocation of the staff and services is carefully planned as per the medical need of the patient, the referral doctor and family members.
InfoMed: What are the differences between a nurse and caregiver?
C2H: Nurses are professionals who have graduated from a Malaysian certified nursing school with a Diploma in Nursing, which is the minimum requirement. They are trained and can perform nursing procedure such as injection, suctioning, wound dressing etc.
Caregiver are those who have the experience of looking after patients, or those who have gone through a basic caregiver course. Their main task is to look after the elderly person that does not involve any nursing procedures.
InfoMed: What are the package and services provided by C2H?
C2H: C2H provides both registered nurse and caregivers services. Our main service includes elderly care, palliative care, maternity care/ post-delivery care, pediatric care, pre and post-operative care, wound dressing, injection services, nursing consultation, doctor home visit service, and physiotherapy at home. We also have packages that are specific to specialised nursing procedures like care for post-stroke and surgical patients, ostomy/colostomy care, infusion therapy and diabetic management.
InfoMed: Who is eligible for home health care?
C2H: In developed countries hospital stays are getting shorter, thanks to the advance minimally invasive procedures. Now more recovery is taking place at nursing facilities and home. Therefore, home health care is suitable for all patients who require nursing care to recuperate at home, and that includes anyone from the newborn to the elderly. Trained competent staff shall be assigned to every client based on their individual care need.
InfoMed: Can you share what you mean by “connected seamless care”?C2H: With technology comes the rise in patient expectations who are accustomed to digital services and connectivity. C2H connected seamless care capitalises on this technological advance, optimising the pathway to connect all the care providers and professionals, patient as well as the family right across the healthcare ecosystem for a continuum of care. The apps will assist family members to keep in touch with the patient progress and keeps the doctors and nurses updated on the daily progress. With this connected seamless care, it provides for an enhanced monitoring system and hence promotes a speedy recovery.
InfoMed: Briefly give us a quick insight into the C2H app and its functions?
C2H: Healthcare is going through its digital transformation. Technology-based wearables, Apps, IoT and telemedicine connectivity are making their presence felt in clinics, hospitals and homes. The aim is to optimize care pathways to reduce hospital stays and improve patient outcomes. C2H App is designed to connect the care pathway, the providers and caregivers, the family and patient in one seamless platform in real time. Daily nursing activity, patient’s vital signs are also captured in the App for monitoring and follow-up. The doctors and healthcare teams involved in the case management have the privy to the records to access the patient’s progress and to review the nursing care plan from time to time.
InfoMed: Is there any other services provided by C2H beside home health care?
C2H: Yes, C2H also work together with the corporate company to improve overall staff health-care, collaborating with hospital or health care bodies in organising some social event to promote awareness on personal health and prevention of certain diseases such as diabetic, hypertension, pre and postnatal talk, etc. Besides that, C2H also participate as a volunteer in some event to provide free health check-up and health education for the society.
In conclusion, C2H’s target is to improve the quality of Malaysia home health care further and create awareness for every individual to take care of their health for maintaining a healthy society. Nursing care is borderless, their services are not necessarily confined only to hospitals but in other healthcare facilities, corporations and homes. C2H began on that premise, and we wish to contribute to quality nursing care in hospitals and beyond.
We also spoke with some of the family members who had engaged C2H for their home care services to have a better understanding of the client’s perspective and their expectations.
InfoMed: Why did you use C2H home care services?
Family 1: “My mother is 86 years old. Due to lacking nursing care at home, she developed six bed sores on her back. Most of the bedsores were at stage 4 and were infected. And she was admitted many times due to sepsis and lung infection. We needed a reliable and comprehensive 24 hours nursing care for the worsening bed sores of my (old and sick) mother.”
Family 2: “My dad suddenly had a massive stroke, become unconscious and was bedridden. He relies on the Bipap machine for breathing and frequent suction is needed. We stayed in the hospital for almost ten months and couldn’t get him discharged as we can’t manage him at home. Till we met C2H, they assist us with the discharge and took care of my dad at home. Their team of nurses, doctors and supervisor were able to manage my dad very well without any bedsore nor complication.”
Family 3: “My dad had uncontrolled hypertension, he suffers from a stroke, is bedridden, requires pump feeding due to the intolerance of bolus feed. We needed help in looking after him at home because we are all working and do not have much experience in the nursing procedures. I used them as they are reliable and is a worry-free service for getting nursing care at home.”
InfoMed: How did you benefit from the home care?
Family 1: By having the professional and comprehensive 24 hours nursing care, the bed sores and the breathing problems were resolved, and the patient survived for another five years.
Family 2: “The fee was reasonable; the nurses are experienced and have good knowledge in taking care of my dad’s need. They are also passionate and responsible with the task given to them. We were able to get someone we could trust to care for my dad for a long period. This helps my family to be mentally and physically relaxed for a long period.”
Family 3: “As they are an organisation, we can count on them to ensure the nurses are professional. They are around to offer their nurses advise as well as manage gaps regarding nurse leaves and holidays.”
InfoMed: Was the supervision and care delivered professionally and any views for further improvement?
Family 1: “Yes, the services and supervision were professionally done.”
Family 2: “They were experienced and knowledgeable of the “know-how” required. Always punctual, responsible for their task, caring, and well trusted by us. We couldn’t have requested more from you guys.”
Family 3: “The supervision and care are professional but would be better if there is a monthly review session with the supervisor/manager to see how to help the patient further and support the family.”
InfoMed: Would you recommend home health care to your family and friends who would need such services?
;Family 1: “Definitely will recommend without hesitation to friends and relatives.”
Family 2: “Yes.”
Family 3: “Yes, and I have already done quite a few referrals.”
Efforts are on the way to make healthcare more holistic and integrated. Complex interrelated health conditions will be addressed across the various dimensions and home health care shall be prominent among them. Primary care and digital technology shall be drivers for this innovative change.
The fast-increasing ageing populations and seniors would require care across specialisation and will be long-term care. Resources to manage the long-term and complex health conditions must avail technology and a well-established specialised primary care to be the driver for the care plan. And its where we anticipate the important role of nursing care, and nurses will form the key caregivers on the ground with the support of the doctors and other professional in the care plan. Care is moving to reach where patients are, more and more services provided in the home – its where the care recipients choosing to age in place want to have care, and its ultimately less expensive. A care system that would bring the doctors and nurses either virtually or physically to the patients. We will see an increase in partnerships between acute-care hospitals, primary care physicians and home health care providers.
Home health care, a new reality that truly supports patients and their ability to thrive in their own space.
A significant development shall be the empowerment of patients and their demand for home care services will grow substantially, a new reality that truly supports patients and their ability to thrive in their own space. The home environment and getting to understand the patients’ lifestyles will enable home care providers to counsel and advise them more meaningfully.
Insurers who take pro-active steps to address the changes will have a significant role in this care process. They must quickly take steps to address this fast-moving change in healthcare delivery pattern which address one of their key concerns, i.e. the escalating cost of healthcare.