HOME
BASED
CARE
1 A
OUTLINE
– Definition and principles of home-based care
– Needs of HBC patients
– Components of home-based care
– Advantages of HBC
– Key players in HBC
– Management of various patients requiring home-
based care *
– Resources needed for effective and sustainable home-
based care
– HBC referral and networking system
DEFINITION
– Care of persons with chronic or terminal
illnesses extended from health facility to
the patients' homes through family
participation and community involvement
within available resources and in
collaboration with health care workers.
WHY HBC?
– Most patients with chronic and terminal illnesses are
discharged before full recovery and therefore the need
for CONTINUITY OF CARE.
– Health institutions have many limitations such as
shortage of health workers and bed capacity.
– Most care providers at home lack basic knowledge on
self protection when caring for patients esp. Those
with HIV infection.
– HBC helps reduce the stigma attached to some chronic
diseases
– There is need to offer continuity of care to prolong
lives and reduce suffering of pts with chronic/terminal
illness.
Objectives of HBC
– To facilitate the continuity of the client’s care from the
health facility to the home and community;
– To promote family and community awareness of
disease prevention and care related to chronic
illnesses;
– To empower the clients, the family and the community
with the knowledge needed to ensure long-term care
and support;
CONT
– To raise the acceptability of terminally ill patients by
the family/community, hence reducing the stigma.
– To streamline the patient/client referral from the
institutions into the community and from the
community to appropriate health and social facilities.
– To facilitate quality community care;
– To mobilize the resources necessary for sustainability
of the service.
Principles of home-
based care
– Ensure appropriate, cost-effective access to
quality health care and support to enable
persons living with chronic illnesses to retain
their self-sufficiency and maintain quality of
life.
– Encouraging the active participation and
involvement of the patient and their family.
– Fostering the active participation and
involvement of those most able to provide
support to the community at all levels.
– Ensuring respect for the basic human rights
Principles cont….
– Instituting measures to ensure the economic
sustainability of home care support.
– Building and supporting referral
networks/linkages and collaboration among
participating entities.
– Building capacity at the household,
community and institutional levels.
– Addressing the differential gender impact of
the HIV/AIDS epidemic and other chronic
illnesses and care
Principles cont….
– Developing the vital role of home-based care as the
link between prevention and care.
– Taking a multi-sector approach to care and support.
– Addressing the reproductive health needs of
persons living with chronic illnesses.
– Targeting social assistance to all affected families
especially children.
– Caring for caregivers, in order to minimise the
physical and spiritual exhaustion that can come with
the prolonged care of the terminally ill.
Home-based care needs
Physical Needs
– Drugs.
– Clinical care such as regular check-ups
– Basic needs e.g. clothing, housing, food, fuel/energy, water, education for
children and income.
– General nursing care ;toilet needs, observation of vital signs, care of
wounds, personal and oral hygiene and comfort.
Physical needs cont..
– Nutritional needs
– Physical therapies;
– Information, education and communication
(IEC), including up-to-date, accurate
information on the disease, on writing a will
and on preparing for the eventuality of death,
on how to take prescribed drugs, prevention
and care of the clients’ illness.
Spiritual/Pastoral
Needs
– Need to be forgiven and accept it;
– Needs to forgive others;
– Need reassurance that God accepts them;
– Needs religious groups support;
– Need freedom of worship according to faith,
– May need for sacraments and fulfilment of
other religious needs
Social needs
– Respect;
– Love and acceptance from others;
– Company of those around them;
– Source of income/income-generating activity;
– Right to own, inherit and give property;
– Confidentiality regarding their condition by all who
know about it;
– Help with the activities of daily living.
Psychological Needs
– Love
– Acceptance
– Encouragement
– Warmth and appreciation
– Reassurance and help in coping with the
disease
COMPONENTS
– Clinical care
– Nursing Care
– Counseling
– Spiritual care
– Social support
– Emotinal
Components 1:Clinical
Care
It is continuation of medical care in
the home.
– Early diagnosis
– Rational and targeted treatment
– Planning for the care.
Clinical care activities
– Ensuring early detection, treatment of
opportunistic infections and other complications.
– Reducing the suffering
– Protecting the client against further infections.
– Preventing transmission of HIV or other
opportunistic infections
– Ensuring that drugs prescribed to the client by the
clinician are administered at home according to
the regimen of intake.
Component 2;Nursing
Care
Aims to promote and maintain:
– Good health
– Hygiene
– Nutrition
– Training family and community members
to give care to those that require it.
Nursing care activities
– Activities to ensure good personal
hygiene; bed bathing, assisted bathing, oral
care, care of the nails and hair etc
– Care for the client’s environment;
– Preventing the transmission of pathogenic
micro-organism;
– Physical therapy
Nursing care activities
cont..
– Maintenance of skin integrity through care of
pressure areas and pressure sores
– Wound care
– Pain management;
– Administering drugs as per prescription to
ensure compliance and relieve symptoms,
– Maintaining the nutritional status of the client;
Nursing care activities
cont..
– Observing of clients to detect problems like
dehydration, dyspnoea, dysphagia, oedema or fever.
Related conditions that need attention include:
– Diarrhoea and vomiting, which may easily lead to
dehydration
– Pain and discomfort
– Chest problems like chronic coughs, colds and
infections
Nursing care activities
cont..
– Skin conditions
– Bed sores
– Nausea, mouth and throat infections
– Taking the patient/client to the hospital or health
facility when need arises
– Reassuring the client at all times
: Counselling and
Psychospiritual Care
– Prolong their life and make it bearable by;
- Positive living and making decisions on the basis of
informed choice.
- Reducing stress and anxiety for both the patients and
their families.
– Helps people to understand and deal with their
problems and communicate better with those
around them.
– Helps clients to cope with their feelings
Social Support
– Information and referral to support groups such as
church organisations, youth groups and other
social organisations.
– Clients need assurance and acceptance by their
families and the community
– They should get involved in family/community
activities depending on their capabilities.
– They should be provided with legal advice and
material assistance.
– Should be given opportunities to write their own
wills.
ADVANTAGES OF HBC
– Patient
- The patient is cared for in a familiar environment
hence less stress and more ability to bear the
illness.
- When people are in their homes, they continue to
participate in family matters.
- When one is at home close to family members,
friends and relatives, there is a sense of belonging
- one is in close contact with familiar people they
are likely to accept their conditions and illnesses
ADVANTAGES OF HBC
cont..
– Family and community
- Caring for sick people at home prevents separation
and holds family members together.
- Less expensive
- Helps them to understand these diseases better and
accept the patients.
- Community cohesiveness is maintained
– Health institutions
-less cost and pressure on resources
PLAYERS IN HBC
– Patient-Identifies care giver, gives consent,
participates in care
– Family Members and Caregiver
– Health care Team
– Health facility
– Community
– Government
Resources Needed for
Home-based Care
– Human
– Finance
– Materials
– Time
Networking for Home-
based Care
– Network- is collaboration, linkage
– a group of individuals or organisations
that work together, undertake joint
activities, or exchange information in
order to strengthen and extend their
individual capacities.
Reasons referral of
patients
– When services or resources within reach are
not able to meet the patients’ immediate needs.
– In cases where the acute phase of the disease
has been dealt with, and it is considered safe to
transfer care to other caring
services/organisations within the community.
– When the caregiver experiences burnout and
has no access to counselling services for
personal growth.
Reasons referral of
patients
– When the caregiver has limitations in
meeting certain needs of the patient, for
example, based on religious beliefs.
– For better, more competent
management in the next stage of
referral.
– For specialised care in a hospital setting,
especially if the patient is deteriorating.
Constrains to referral
– Competition among various
organisations, so that they do not
disclose what they are doing and
which services are offered. They
prefer to work in isolation.
– Lack of evenly distributed community
HBC programmes, with the result that
some areas lack services and some
are overcrowded.
Constrains to referral
– Lack of resources needed for patients to
travel from one point to another.
– Lack of referral and networking guidelines
as well as standardised referral procedures.
– Ignorance among family members about
HBC due to lack of awareness and proper
guidance.
– Fear of breach of confidentiality
Community
Mobilisation
Definition; The process of getting the
community incorporated to fully participate
in the programmes for the purpose of
ownership and sustainability.
The community must participate and get
involved in the decision making process,
planning, organisation, implementation and
monitoring of activities associated with HBC
The importance of
community
mobilisation
– Prepare the community for participatory action.
– Create awareness about their health problems, causes,
prevention and care required.
– Identify problems together with the community and
seek means of solving them.
– Gather information about the community’s beliefs’,
feelings, myths and misconception of their problems.
– Identify available resource and how the resources can
be used to solve the problems.
– Establish relationships within the community.
– Ownership and sustainability of the programme
Factors that can hinder
community mobilisation
are
– Lack of involvement in problem identification
– Lack of appropriate information
– Lack or mismanagement of resources
– Insecurity
– Lack of social structures
– Communication barriers
– Poor health
Factors cont..
– Lack of ownership
– Lack of interest
– Poor infrastructure
– Lack of knowledge of other partners
– Social differences (religious, education,
cultural, economic, political, tribal)
– Poor leadership
– Man made or natural disasters
– Poor timing
Mobilisers
– Local administrative officers and leaders such
as chiefs, assistant chiefs, councillors and area
members of parliament.
– Leaders of various programmes, for example,
district AIDS control committee.
– Religious leaders.
– Organised groups, for example, religious
groups (women’s guild), youth groups, women
groups (the Maendeleo ya Wanawake
organisation).
Mobilisers
– Community based health workers.
– Community Own Resource Persons
(CORP), for example, traditional
birth attendants and traditional
healers.
– Other ministries workers like social
workers, school teachers.
– Patients themselves
Ways of mobilising the
community are:
– Meeting at specific prefixed times.
– Existing committees, such as the village
development committee.
– Home visits to groups and individuals.
– Announcements at church, mosque, temple,
and school.
– Use of mass media electronic/print
Process of mobilization
– Planning and organizing self
– Community entry
– Conducting community mobilization
sessions
– Evaluation and reinforcement
42 FINNALLY,
THANK
YOU
