Delivery of healthcare to a patient in the patient’s home environment is preferred by many.

Home healthcare (HHC) maintains the quality of life and is very useful in chronic illness. It is gradually replacing the conventional healthcare market in certain areas. Poor patient-bed ratio and increasing life expectancy is making HHC mandatory.

Reduction in hospital stay, especially after a major operation or an acute illness, is always welcome. HHC may be 40 per cent cheaper than treatment in a hospital. Though presently in a nascent stage, it is an unexplored market in the health industry. Organisations run such centres as a business initiative and it is becoming one of the fastest growing sectors in the health industry.

The standalone family physicians are being rapidly replaced.

Unfortunately, many young people consider senior citizens as a burden. Children who live outside Bengal are finding HHC very useful to manage elderly family members. Many are finding old age homes socially unacceptable as it is always better to manage at home.

Convenience, logistic benefits and affordability are making care at home more acceptable. The Covid pandemic has increased the requirement of HHC.

Women

Women have always been involved in a dual role as provider and recipient of home healthcare. Women have been caregivers of home healthcare since well before the initiation of professional services. Mostly wives and daughters-in-law performed these duties, along with a female help. Most of them were not economically independent and did such duties emotionally and for love of the family. Sometimes there was no option. And this service still continues.

These aspects have been studied and instances of self-sacrificing attitude in women have been reported. The roles of women were under-acknowledged, unrewarded and mostly not compensated. The service was free. These unpaid contributions to home healthcare, though silent, have been an invaluable contribution to society. This has probably laid the foundation for the present day commercial services. A feminist philosopher wrote: “The principal insight of feminist ethics is that oppression, however it is practiced, is morally wrong.”

Today, HHC is much more professional and many corporate hospitals and organisations are offering adequate services. Still most in the workforce are nurses or female workers. Their dignity and safety need to be taken care of as they work in patients’ homes and not in hospitals.

It is unfortunate that verbal and other misconduct have been reported on some occasions.

Home healthcare

Home-based healthcare is an initiative to reach households beyond the boundaries of a traditional hospital infrastructure.

A team of doctors, trained nurses and professional healthcare staff are available to provide life assistance services. Various equipment can be provided like cardiac monitors, nebulisers and pulse oximeters. Even an ICU can be set up at home. Air bed is provided for geriatric or terminally ill patients. Equipment is available both for rent and sale.

There are various benefits of medical services at home.

• Convenience of a homeenvironment
• No chances of hospital-acquired infections
• Cost savings are significant
• Less doctor visits at the hospital
• It is not necessary to visit the hospital Emergency for every admission
• Personalised care by professionals.

In future, if day-care hospital beds are not available, chemotherapy can be administered at home in low-risk cases.

Healthcare services at home are opted mostly by elderly people. Some do not have the capacity of self-care like walking, bathing or eating. Some avail of the services for independent living like light housework, preparing meals or taking medications.

Today, there are many organisations providing HHC. However, some people opt for hospital-based home-care services for brand value.

Future directions

The requirement of healthcare at home is increasing all over the world. Insurance agencies should cover these services fully on doctors’ recommendation. The facilities offered by a particular centre should be clearly highlighted. If there are extreme shortage of beds, hospital admission should be done only for those suffering from acute or critical illness. Home healthcare should be capable to manage all other patients. It is important that both the doctor and the patient are satisfied with the treatment offered at home.

Certain aspects are crucial for home healthcare in future.

• It should be patient-centred and the treatment evidence-based
• Better monitoring and easy contactability
• It should be technology-enabled and supported by a mobile app
• Services should be affordable for use by all sections of society
• The government must regulate these services like hospitals.
• Appropriate and proper use of home healthcare services can alter the concept of healthcare in Bengal.

Gautam Mukhopadhyay is a surgical oncologist trained at the Tata Memorial Hospital, Mumbai. At present, he is the clinical lead, department of surgical oncology, Narayana Health Cancer Institute