Home Care , Lab Tests, X-rays, Doctors AT HOME
24 hours a day
Home care worldwide
Home Care
USA is the country with the longest tradition in home care provision. The first associations appeared between 1885 and 1889, when home was the workplace for most nurses. By the year 1905 455 visiting nurses were employed by 171 associations. Today there are as many as 20,215 home care organizations in the USA, providing home care to more than 7 million residents, services which cost over $38 billion every year! Although today most countries seek for randomised controlled trial evidence to decide whether they will support the development of home care, the Americans are so accustomed to the home care notion that they spend these huge amounts of money on home care provision without RCT evidence.
Estimates for the U.S. indicate that most home care is of the informal
variety with families and friends providing substantial amounts of care,
including very high tech kinds of care as well as simpler assistance with
bathing or dressing. For formal care, the health care professionals most
often involved are nurses followed by physical therapists and home care
aides. Other health care providers include respiratory and occupational
therapists, medical social workers and mental health workers. In the U.S.,
home health care is generally paid for by private employer-sponsored health
insurance or public payers (Medicare and Medicaid).
In the UK 2.7 million contact hours of home care were provided to around
424,000 households, during a survey week in September 1999. Home care
aims to enable people to remain at home rather than use residential or
nursing care. Care workers visit service users in their own home and help
with daily tasks such as getting up, going to bed, dressing, toileting,
personal hygiene, some household tasks, shopping, cooking and supervision
of medication.
World Homecare and Hospice Organization (WHHO) made in 1995 an attempt to collect in one place information on what home care services were available in each country of the world [9] . After soliciting 187 countries, 63 of them reported that some form of formal home care services was in current operation in their countries.
Assistance to the disabled, nursing, health education, palliative treatment, social work, physiotherapy, rehabilitation, vaccinations, wound care, are some of the vast fields in which home care has its predominant role.
Hospital at Home. The International Scene and Present Innovations [2].
During the last few years the idea of providing care at home, so as to save some length of stay, has emerged and, being fascinating, promising and challenging, it has been realized in a few schemes. Although these practices are actually advanced Home Care services, they are usually called “Hospital at Home” or “Hospital in the Home” (Australia), to be discriminated and evaluated separately from more conventional home services.
Most of the reported Hospital at Home settings are mainly oriented to early discharge of patients, previously treated in hospital and usually for the last few days of their treatment, when minimal interventions are required. Some Hospital at Home are called “admission avoidance” or “total episode substitutions”. However these patients are initially evaluated in the emergency room of a hospital and usually hospitalized for one day. Furthermore only patients who have a definite diagnosis and whose conditions require very “light” support are judged to be eligible for Hospital at Home. In almost all of the cases care is offered only by nurses and in very few of them is there some contribution by general practitioners .