A recent story in The Australian highlighted that the government will begin to move programs like chemotherapy, dialysis and palliative care out of the hospitals into the home. It is obvious that Australia will experience balanced clinical and social home care like in the USA. It’s a solution that has been talked about and implemented since the 1990s through various programs including Hospital In The Home and recently Health Care Homes. Now there is news that an American home care franchise, First Light has arrived on the Australian shore! First Light is ranked as one of the best American franchises to buy in 2018. It is a care-giving organisation that provides home care for the aged, the disabled, those who are recuperating and busy moms. They provide any service that is specifically needed by their clients. It is obvious that US style home care is coming our way!
First Light has arrived in Australia at a time that we are moving more towards home-based care for the aged and those suffering from chronic diseases. Three major things are taking place in Australia. First, there is growing increase in the number of chronic disease sufferers. Secondly the population of old people is increasing and each elderly person suffers from at least one chronic disease and a disability creating a terrible trifecta. Thirdly, the aging and the chronically sick people, whose numbers keep growing every year, are putting pressure on the health care system which cannot cope with the demand. Meanwhile the infrastructure is aging and the nation cannot keep on building more hospitals and homes for the aged. As a result, the chronically ill and the aging are encouraged to stay at home. When they need acute care, they are hospitalised and then sent back home as soon as they are better.
For the aged, leaving home can be a very painful experience. Who enjoys leaving their loved ones and their community to go and live in an institution? Moving aging people to a home for the aged can create depression and shorten their lives as they give up on life. Research has found that it is more beneficial for the old people to age gracefully at home. They can live an independent or semi-independent (with support) life at home. They can live with their families or live in their own homes with frequent visits from their families. They can socialise and even volunteer to keep themselves busy. Having something to look forward to makes them feel relevant and needed and that keeps them strong and hopeful.
The coming of First Light with a proven system of home care will most likely accelerate the paradigm shift in Australia’s Health Care Homes. It is possible that a number of care giving organisations will buy the franchise and give a standard set of care for standard prices.
A number of stand-alone health care programs in Australia, including Health Care Homes, target more or less the same people. Some of these programs can be integrated. It is time for some of the services to be standardised and costed uniformly throughout the nation. Then we can have high quality care for everyone who needs it at the right place at the right time.
Integration should include health records. Right now, records are not shared and when patients move from one service provider to another or from one part of the country to another, there is discontinuity of health records. A GP taking care of a patient after hospitalisation may fail to access the health records at the hospital, making it difficult for the GP to continue properly the care given at the hospital. Integration will not work unless there is proper sharing of records, and that will not happen unless everyone goes digital. Adoption of My Health Record therefore needs to be speeded up throughout the country and government must announce a deadline for its adoption. There should be no excuse as to why some service providers have not adopted it.
Home care will work best through telehealth. The idea is to minimise travel to the doctor and to prevent unnecessary hospitalisation by giving adequate care at home. That means patients have to be monitored and seen in their homes. Because no doctor has the capacity for home visits, telehealth can be implemented for all elderly people living at home and all chronic disease sufferers. Then they can be seen regularly via teleconferencing and their vital signs can be shared via a mobile phone App or via computer. Doctors will react only if there is anything wrong and either send a prescription to the pharmacy or to the patient by email. The pharmacy can then deliver the medication to the patient. All that can take place without the need for the doctor or the patient to travel for an appointment. By monitoring patients and taking action quickly when there is a problem, acute illness is prevented and patients will not need hospitalisation too often.
Integration of the system will only work if all service providers come on board. They will all have to adopt similar systems, be willing to share health records, and be willing to work as part of a team of service providers that look after certain patients. All health care workers and care givers will have to become enablers of integrated health care, playing their role to the full as team members.
Because the hospitals are too full and cannot cope with demand for care, everyone who receives care at home should not be taken to the hospital for minor emergencies. That is why the idea of Urgent Care Clinics should be explored and hopefully adopted. We can turn some primary care clinics into urgent care clinics so that they attend to minor emergencies such as cuts, colds and flu. Then emergency rooms and hospital beds are left free to take care of acute cases of illness and injury. Emergency personnel manning ambulances can work according to guidelines, taking the right patients to the hospital emergency rooms and diverting the rest to Urgent Care Clinics.
For the system of home care to work well, we need care navigators. The healthcare system is complex and most of the time patients do not understand what care they are supposed to get, why they must get it, and where they must get it. Not to mention how to get the right funding. For someone who is very sick or disabled or old and frail, it can be quite confusing and daunting. A patient can spend a lot of time and money going to the wrong place and delaying their treatment. Other patients give up before getting the right care because they simply do not have the energy and the money to pursue it. Care navigators play the role of explaining everything to the patients and directing them to the right place. With the assistance of care navigators, patients can go to the right place and get the right funding.
We have already seen Medibank insurance start to drive the at clinical care in the home model, with Medibank at Home. It is critical to note this also includes Rehab in the Home after knee or hip replacement surgery. Now we watch and see how Australian home care service providers will react to these announcements. Such changes may be the beginning of implementation of an integrated care in the home system in Australia.
