Part A/Module A5/Session 2 Part A: Module A5 Session 2 Community Home-Based Care

Part A/Module A5/Session 2

Part A: Module A5

Session 2

Community Home-Based Care


Objectives

1. Discuss the definition, objectives and types of home-based care

2. Discuss the essential elements and principles that should be included in and guide home-based care programs

3. Describe major factors to address when assessing potential home-based care clients and families

4. Discuss issues of home-based care that are specific to their local situation


Definition

The provision of comprehensive services, including health and social services by formal and informal caregivers in the home in order to promote, restore and maintain a person’s maximal level of comfort, function and health, including care towards a dignified death.

CHBC includes physical, psychosocial, palliative, and spiritual activities and is a very important component of the continuum of care, which extends from the hospital, through different levels of the health and social welfare facilities to the home.


Goal of CHBC

The goal of CHBC is to provide hope

through good quality and appropriate

care that helps patients and families

maintain their independence and

have the best quality of life.


There are different types or models of home-based care, depending on national policy or local community situations.

In determining which model is best for a given situation, it is important to take into account such factors as

• cost• stigma• community resources• Sustainability• adequacy of systems available to support CHBC

Models of Home-Based Care


Facility-Based or Outreach

Usually a hospital outreach program, which sends outreach health care workers or teams out to periodically visit the homes and families of PLHA

Often focus on addressing the nursing and medical needs, but have increasingly integrated psychosocial support


Community-driven and owned: typically relies on volunteers who reside in the communities covered by the program

Volunteers are trained to provide basic nursing care, emotional and spiritual support to the patient and family members

Volunteers instruct family members in caring for the patient and provide back-up support through regular visits

Transport costs minimal since volunteers live close to families

Challenge is to maintain and support the volunteers

Community-Based Model


Integrated Model

Combination of facility and community – based models: a community-based program which relies on local health facility for training, supervision, and supplies for home-care kits and ensures referrals to patients back to the facility as and when needed

Evolution into this model is a natural one in response to needs of communities, families, and patients. This can result in a continuum of care through synergistic working relations and referrals. For example, there is a need to explore linking pharmacies with HBC services.


Community Day Care Model

Patients come to a site for a few hours during the day and get services such as symptom monitoring, drugs, recreation, and counseling. This gives caregivers a respite.


Essential Elements of Home-Based Care

Preventative

Instructive

Therapeutic

ARV adherence support

Rehabilitative

Long-term maintenance

Palliative care & pain relief


Examples of Services that can be included in HBC


Provision of Care

Basic physical care • Recognition of symptoms • Treatment and symptom management

Referral and follow-up

Prevention for patient and caregivers, including provision of supplies such as condoms, household bleach


Provision of Care, continued

Basic nursing care

• Positioning and mobility

• Bathing

• Wound cleansing

• Skin care

• Oral hygiene

• Adequate ventilation

• Guidance and support for adequate nutrition


Palliative care

See Part A Module A5, Session 1 on Palliative Care


Psychosocial Support and Counseling

Effective psychosocial support and counseling is known to improve quality of life

Caregivers, including both the family and the CHBC team, must themselves receive support if they are to support patients

Burnout is a major risk for families and HBC team members


Care of Affected/Infected Children

Programs should include

• advance or succession planning for surviving children and dependents

• HIV/AIDS and other terminal illnesses have a profound effect on children’s lives. Psychosocial support is critical and involves an ongoing process of meeting their physical, emotional, social and spiritual needs.


• promote an enabling environment for psychosocial support for vulnerable children

• foster an expanded response by families, communities, governments, faith-based and other organizations for the promotion of psychosocial support for children.

Care of Affected/Infected Children, continued

CHBC programs can


Care of Affected/Infected Children, continued

Programs should include:

• Information and education for patients and families

• Training for family caregivers • Immediate practical support for children and

families in distress • Established linkages and referral

mechanisms for services such as legal support


Patient Assessment in the Home and Developing a Care Plan


Use a holistic approach

Begin with a thorough assessment which addresses

Patient and family needs and current capacity for

• maintenance of basic hygiene • good nutrition • comfort measures • prevention of infection transmission • symptom management • legal support • taking drugs and medical measures which require physician

input • food and income security • source of psychosocial and spiritual support

Holistic Approach


Set Realistic Goals

With the patient, family members, and interdisciplinary team, establish a care plan based on the assessment above

Set realistic goals based on the patient’s condition, stage of the disease, care plan, and resources available


CHBC Linkages

CHBC volunteers can participate as DOTs monitors in programs managing HIV-infected patients with TB

Volunteers can also participate as monitors for ARV DOT patients

CHBC programs can provide mechanisms for support in PMTCT programs including documentation of inadvertent negative outcomes

CHBC plays a role in ART adherence for MTCT programs or chronic ART management


Basic Principles to Guide HBC Programs

It is good practice to include all sectors of society, i.e., communities, public and private institutions, traditional groups

While CHBC does not aim to shift the burden solely onto the community there should be active efforts to empower families/communities to take responsibility for their health with the community sharing responsibility for care in that community

People living with HIV/AIDS should be integral to the planning, design, monitoring and evaluation of programs


Provider services along a continuum of care that responds to prevention and care needs for the infected and affected across different stages of illness and in a variety of settings

Home-based care workers are ideally a part of a multidisciplinary team that provides access to the diverse service needs of patients and families

It is essential that there be care for the caregivers: family members, community volunteers, and health care workers

Basic Principles, continued


There must be an environment and local capacity (through awareness-raising and skills-building) to support shared confidentiality regarding disclosure of HIV status by patients to their families and caregivers

HBC should be an entry point to other services such as legal aid, household aid and facility-based care for patients and families

Programs must address the unique needs of orphans and vulnerable children

Basic Principles, continued

Documents

Part A/Module A5/Session 2 Part A: Module A5 Session 2 Community Home-Based Care