Home-based Care (HC) is defined as the provision of health services directly in the home to promote health and comfort. It aims to shift care from hospitals to the community. HC targets those who need assistance to live at home, including the healthy, at-risk, disabled, recovering, and terminally ill. Stakeholders include healthcare professionals, NGOs, community members, and clients. HC has advantages like reduced costs, empowerment, and person-centered care but challenges include stress on caregivers and resource constraints. Home visits are a key part of HC and include illness, end-of-life, assessment, and post-hospitalization follow-up visits.

1. Home-based Care (HC)
By Team D (Dr Ahmed; Dr Okeke)
Department of Family Medicine
University of Uyo Teaching Hospital
19th March, 2021
Presentation on

2. Outline:
• Background
• Definition
• Types of HC
• Rationale
• Target Population
• Stakeholders
• Principles
• Objectives HC
• Advantages & Challenges
• Home Visit
• Conclusion
• References

3. Case 1
• U.E.B was a 75 year old retired civil servant who
presented to the GOPC with a 2 year history of
frequency, nocturia, urgency, poor urinary stream
and a feeling of incomplete bladder emptying.
• Blood pressure was 160/90mmHg and DRE
showed an enlarged prostate.
• Prostatic USS done showed an enlarged prostate
with a volume of 81.62cm3 with benign features
while the PSA was 93.2ng/ml.
• He was placed on antihypertensives and refered
to the urology clinic

4. Case 1
• U.E.B defaulted from care for 2 months but presented
to the Emergency unit with acute urinary retention
which was relieved with a urethral catheter.
• He continued his follow-up clinic care. A prostate
biopsy done showed he had prostatic adenocarcinoma.
• He was placed on contiflo and flutamide. He was also
counselled on prognosis and possible treatment
options. He however opted for a conservative
approach and stopped attending his clinics.

5. Case 1
• U.E.B was placed on home-based care as sponsored by an NGO. Each
monthly visit consisted of a medical doctor, a nurse, a CHEW and a driver.
• He was managed for hypertension and low back pain while his urethral
catheter was changed monthly. His living environment was assessed to
ensure U.E.B’s functionality and comfort.
• He was counselled on the terminal nature of his illness and need to make
peace with himself and his family.
• Owing to a dispute between him and his late wife, 3 of his children were
estranged from him. A family conference was organised where the nature
of his illness and need for social support for him were discussed with his
family.
• Attempt was made to reunite the family but this was unsuccessful. U.E.B’s
home-based palliative care had continued and he was doing fairly well.

6. Background
• Home-based care is a common practice among informal home
health care providers (TBS, TBAs, CHEWs, Herbalists etc) in Nigeria
however this practice is rare among the formal health care
providers.
• tt has been noted that upto 65% of deliveries take place in home
settings/communities via TBAs.
• Research evidence suggests that most people would rather be
cared for at home and that effective home care improves the
quality of life for ill people and their family caregivers.
• Between 70% and 90% of illness care takes place within the home.
Throughout the world, most caregivers are family members and
they are valued as the main source of care for ill people.

7. Background
• In Nigeria, we have a growing population of
over 200 million currently, a low NHIS
coverage currently projected at around 5%,
upto 70% of nigerains still financing their
health care needs by OOP expenditure and an
estimated 40% of population still living in
poverty, home based care can be instrumental
in mitigating these deficiencies.

8. What is Home-based Care?
WHO:
Home based care is defined as the provision of health
services by formal and informal caregivers in the home
in order to promote, restore and maintain a person’s
maximum level of comfort, function and health
including care towards a dignified death.

9. HBC may also be defined:
HBC may also be defined as any form of
assistance provided to a sick person directly in
the home by family, friends and members of the
local community, cooperating with the advice
and support from the trained health workers

10. Types of HBC Services:
The main goal of HBC is to provide hope through high-quality and
appropriate care that helps family caregivers and sick family members
maintain their independence and achieve the best possible quality of
life. These services with respect to formal health care services include
• Palliative
• Therapeutic
• Long-term maintenance
• Rehabilitative
• Promotive
• Preventive

12. Rationale for HBC
• Shortage of hospital bedspaces.
• Inadequate number of health care staffs including allied health
professionals in the public sector.
• Increasing demands of curable conditions on existing institutional
care.
• Hospitals which are crowded and over-stretched, are often
unsuitable for managing patients with terminal or long-term
diseases.
• Cost of institutional care
• Desire by patient and/or family especially in settings of terminal
illness.

13. Whom does the programme assist?
Generally includes people who need basic support services to continue to live
and/or die in their community and without which they would have been
either prematurely, inappropriately or unavoidably moved to institutional
care.
The programme is targeted at:
• Healthy people
• People at risk such as frail older persons, pregnant women and children
• People with moderate to severe functional disabilities
• People recovering from illness and/or in need of assistance e.g. post
deliveries or after specific treatment.
• Terminally ill persons
• Persons living with HIV/AIDS, any other debilitating disease and/or
conditions e.g. mental illness, substance abuse and other chronic illnesses.
• Any other disadvantaged group/person in need of such care

14. Stake Holders in Management of HBC
• Generally stakeholders in HBC includes anyone either directly or indirectly
involved in the well-being of the sick person(s) or individuals in need of
care at home. However they may be classified into:
• Formal sector: policy development, organization/coordination of care,
allocation of resources, training and capacity building, advisory function,
creating an enabling environment and system support. Comprises of
health care professionals.
• Non-formal sector: Include NGOs, FBOs, DPOs and CBOs
• Informal sector: including family members, CHEWs, Volunteers,
community members.
• Client/Consumers: Who is expected to play an active role as well.

15. Principles of HBC
• Holistic care/Comprehensive care
• Person-centered and culturally oriented care
• Collaborative efforts between the different sectors
• Ensure capacity building and empowerment
• Lifetime coverage
• Sustainable
• Ensure Equity
• Specific
• Community involvement
• Focuses on components PHC

16. OBJECTIVES OF HOME-BASED CARE
• To shift the emphasis of care to the beneficiaries – the community
• To ensure access to care and follow-up through a functional referral
system.
• To integrate a comprehensive care plan into the informal, non-formal
and formal health system via collaborative efforts
• To empower the family/community to take care of their own health.
• To empower the client, the carer(s) and the community through
appropriate targeted education and training
• To reduce unnecessary visits and admissions to health facilities.
• To eliminate duplication of activities and enhance cost-effective
planning and delivery of services.
• Be pro-active in approach

17. ADVANTAGES OF HOME-BASED CARE
• Reduce the pressure on hospital beds and other resources
at different levels of service.
• Reduce cost of care within the system.
• Feelings of ownership, responsibility and accountability
are evoked.
• Allow people to spend their days in familiar surroundings
and reduce isolation.
• Enable family members to gain access to support services.
• Promote a holistic approach to care and ensure that
health needs are met.
• Create awareness of health in the community
• Intervention is pro-active rather than reactive.
• Right to decide about care within own environment

18. ADVANTAGES OF HOME-BASED CARE
• Promotes job creation especially in non-formal sector.
• Decision making is inclusive
• Beneficial to family and friends as it allows more direct time with
clients and involvement in care giving.
• Care will be individualized and person centered.
• Avoid unnecessary referrals to and from higher levels.
• Avoid unnecessary and/or prolonged admission to health care
facilities or institutions.
• Ensure that caregivers and all key role players are well informed
(knowledgeable), receive adequate skills training.
• Ensure continuity and consistency in service, quality assurance
and healthcare management.

19. CHALLENGES OF HOME-BASED CARE
• Emotional and physical strain and stress experienced by
caregivers.
• Insufficient empowerment of clients and caregivers regarding
care as well as inadequate support structures.
• Uncertainty about the duration of the situation.
• Dependency - allows for dependency of the client.
• Social isolation, related to confinement of the person to bed
and the home.
• Emotions such as rejection, anger and grieving.
• Economic constraints
• Fear or mistrust of the primary caregivers.

20. CHALLENGES OF HOME-BASED CARE
• Barriers to access
• Poor resource allocation, e.g. respite centres/care and
equipment.
• Lack of volunteerism.
• Programmes are not community driven and fragmented.
• Self-neglect - often refusal of intervention/care.
• The concept of partnerships/collaboration is lacking as
government is often the sole provider.
• Confidentiality of diagnosis - unwillingness to disclose.

21. Home Visit
• Home visit is a service made by the health
professional to a patient’s home which allows
the health worker to assess the home and
family situations in order to provide the
necessary health related care.

22. Types of Home based visits
The four major types of home visits are;
• Illness visits
• Visits to dying patients and their families,
• Assessment visits and
• Hospitalization follow-up visits or monitoring visits

23. Types
Illness home visits
Emergency
Acute illness
Chronic illness
Dying patient home visits
Terminal care
Pronouncement of death
Grief support

24. Types
Assessment home visits
Polypharmacy and/or multiple medical problems
Excessive use of health care services, Immobility, social isolation
or suspected abuse or neglect, Recent catastrophic diagnoses or
possible need for nursing home placement
Hospitalization follow-up home visits
Acute illness,
injury or surgery
Parents with newborn infants

25. Conducting the Home Visit
• One of the keys to conducting a successful home visit is to
clarify the reason for the visit and carefully plan the
agenda.
• Preplanning allows the physician to gather the necessary
equipment and patient education materials before
departure.
• Physician must discuss with patient and relatives/caregiver
on setting an agreed time of appointment and date, and
ensure a reminder is sent before departure.
• The physician must develop a checklist of
materials/equipments and drugs needed and reviewed
before departure.

26. Conducting the Home Visit
• The physician should have a map, the patient's
telephone number and directions to the patient's
home.
• The physician, patient and home care team should set
a formal appointment time for the visit. Coordinating
the house call to allow for the presence of key family
members or significant others can enhance
communication and satisfaction with care.
• Finally, confirming the appointment time with all
involved parties before departure from the office is a
common courtesy to the family as well as a wise time-
management strategy

27. Home Visit Checklist
• Immobility
• Nutrition
• Housing
• Other people
• Medications
• Examination
• Spiritual
• Safety
• Services by home health agencies

28. Suggested Equipment for Home Visits
Essential Physician-supplied equipment:
Lubricant
Diagnostic set
Patient records and charting materials
Prescription pad
Sphygmomanometer (various cuff sizes)
Stethoscope
Sterile specimen cups
Glucometer
Thermometer
Tongue depressors
Urine dipsticks and other relevant POCT materials

29. Suggested Equipment for Home Visits
Patient-supplied equipment (as needed)
Glucometer
Peak flow meter
Scale
Sphymomanometer

30. Conclusion
• The utilization of HBC as a tool in the health
care system diminishes financial hardship,
improves health status remarkable as well as
QOL of patients, promote empowerment of
families and communities, as well as
community participation and togetherness,
not without stating that it will strengthen the
health care system at the grass root level,
PHC.

31. Bibliography
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