What Is Home Healthcare and What Are the Different Types?

What is home healthcare?

To answer the question of what exactly home healthcare is, it is the supportive care provided by professionals in the medical field such as ICU nurses, doctors and physiotherapy, providing assistance for general activities, ICU care and the general fitness for individuals that require them, all of this at the comfort of their homes

What are the Different Types of Home Healthcare

Under the category of home healthcare, there are three areas: 

• General Geriatric care
• Advanced Home Health Care
• Palliative care

General geriatric care & general assisted living, ranges from regular intermittent visits by physician or nurses to check vitals and keep a track of compliance of medications to live in medical caretakers and to help with daily activities of their life. This is more of a preventive care approach, which makes it possible for early signs of serious illness to be noticed.

Advanced home healthcare, the nurses remain with the patients full time and take care of all their needs, managing the support systems such as respirators, oxygen supplementation, intravenous medications and intense monitoring of the patient health condition. This category of home care also involves the involvement of physiotherapists and regular physician visits.

Palliative care, or comfort care, is usually for patients needing end of life care due to terminal illness or other conditions. The treatment involves keeping them comfortable and calm during their last stages of life and making them as painless as possible.

What does home health care cost in Chennai?

The costs of home care differ based on the type of home care opted for and level of nursing provided for care. It can be safely mentioned that it would be about 40-50% cheaper for advanced home care if compared to hospitalization. Services, such as nurse visits or live-in caretakers, work out cheaper by about 20-30% compared to a hospital, with the advantage of having services at the comfort of their home and avoiding travel or exposure to infections at hospitals.

At NORMS advanced home care can cost between 6000-9000 per day which is inclusive of medical equipment for rent, advanced level of nursing, physiotherapy and disposables as well

For general assisted living at NORMS it would cost in the range of 5000 – 60000 per month based on the services provided and level of assistance

Types of Home healthcare professionals 

Concerning the reliability of the care, the healthcare professionals are trained and can be divided into 4 levels:

Caretakers

The caretakers are medically trained to handle patients and help with daily activities such as washing up, feeding, and resting. What the caretakers lack are medical abilities such as checking vitals, dispensing medications as per prescription, or taking medical decisions like shifting to the hospital or deciding the dose of certain medications based on certain parameters.

Basic Nursing

The basic nurses are the ones with a minimum of 1-2 years of experience who can do all the duties of a caretaker. In addition, they would check vitals, keep records of the same, dispense medications as per prescription, and carry out specific orders in medicine management based on the condition of the patient. They also communicate with the doctors to update medical conditions.

Advanced nursing Level 1

Advanced-level nurses typically have 3-4 years of hospital experience. They can handle all the duties of a basic nurse, and in addition, they can handle tube feeding, certain supportive aides like colostomies, and wound dressings. They do not handle respirators, tracheostomy care and advanced level of monitoring

Advanced nursing Level 2

Advanced level 2 nurses are usually nurses with a minimum of 5 years of experience and would have ICU training and experience in ICUs at hospitals. They can handle patients with tracheostomies, respiratory support, tube feeding, and an advanced level of monitoring.

What are the benefits of home healthcare?

Home healthcare has a list of benefits for the patient in terms of accessibility, comfort, and quality services. 

In regard to preventive geriatric home care, the main advantage is the prevention of major illness or major hospitalization. This is achieved through regular checks of health and compliance with medications and treatment. 

Moving on to advanced care, the main advantages are the reduction in the chances of hospital acquired infection or secondary infection and the comfort of home for the prolonged rehabilitation. Being admitted for long periods for rehab leads to increased chances of infection and the patient’s mental state being severely affected due to the isolation. This also applies to surgical care, where the likelihood of a wound becoming infected is lower, making rehabilitation much faster. 

In terms of palliative care, comfort plays the biggest role, as this allows for the family members and loved ones to remain with the patient as they peacefully rest their time away from life.

Maternal care, the mother gets to be well taken care of during the antenatal period with regular antenatal exercise at home, diet counselling. Post childbirth the nurses deputed are specialized in child and mother care, and they help the mother recuperate while also caring for the newborns.

Setting up home healthcare can be seen as a hassle initially, which is why we make the process as smooth as possible so the patient can receive the utmost comfort after discharge from the hospital. We assess the patient’s medical condition and the list of medical equipment required at home. 

Once this is done, the family members are counseled by our head of medical services on all aspects of equipment and medical care at home.

The counseling session includes several aspects to help the patient’s family understand the situation moving forward:

1. Medical condition will be explained
2. The best & worst outcomes of treatment 
3. The possible emergencies to expect
4. Reaction to emergencies 
5. Equipment usage and cost effective solutions 
6. Nursing team, what to expect and limitations in home care for them 
7. Frequency of Physiotherapy 
8. Frequency of doctor visits 
9. Frequency of labs & imaging 
10. Review with primary physician 
11. Cost changes over the period of time based on patient improvement 
12. Plan of expenses for the services, disposables, medical equipment rental is discussed 
13. Logistics and feasibility of home care is planned

Regarding the payment for the services, there is a charge for the assessment and counselling when it is done, if services are available with us, the amount is refunded at the time of initiating our services at home.

To make the process of payment easier when moving to our services, there are several payment plans that can be chosen:

1. Monthly payment – The billing cycle for this would be from 25th-24th and once a month invoice will be raised. At the time of starting services there will be a security deposit which is refundable at the time of closure of services
2. Prepaid payment – One can choose to pay once in 10/ 15 days in advance for all services which are expected for the patient. Every 8th/13th day the next payment needs to be made for the services to continue. Security deposit for this system may be applicable which will be intimated at the time of estimate

Regarding the services that cannot be provided by us, they include MRI scanning, CT scanning, which are not possible at home. 

Ultrasound imaging, Doppler, Echo will not be possible at home either due to government restrictions regarding ultrasound machines

In relation to medical equipment, there is the option of purchasing or leasing them:

Purchasing

Pros:

• Offsetting Revenue: There is the potential for additional rental revenue from third-party tenants, which lowers overall cost to ownership.

• Lower Occupancy Cost: Today’s interest rates are still near historical lows. Owners usually enjoy a lower cost of occupancy than lessors.

• The biggest benefit to owning the equipment is that after it has been paid off, the health system retains a marketable asset from which it can continue to generate revenue or which it can use to reduce its operating expenses by not having to pay for space it needs to conduct its operations. Additionally, the property value of the asset may appreciate over time, providing owners with additional financial benefits.

Cons: 

• Higher Up-Front Costs: The up-front costs to own usually consist of an equity investment in the property and tenant improvement costs  (However, in some cases, creditworthy physician groups and hospitals can receive 100% financing)
• Long-Term Commitment: Because of higher up-front costs, higher disposition costs, and risk in the sale price, ownership is a long-term commitment.
• Owners who have financed with a loan that does not fully amortize are subject to interest rate risk at time of refinance. Because interest rates are currently near historical lows and are set to increase in the future, refinancing will likely result in higher financing costs and translate to higher ownership costs for equipment.
• When health systems own medical equipment, they have to manage and upkeep those assets, which most healthcare organizations are not in the business of doing. Proper management of medical equipment requires time, expertise and resources, including property managers, accounting professionals, maintenance staff, and legal counsel. All of this adds to the cost of owning medical equipment.

Leasing

Pros:

• Flexibility: The tenant’s commitment to a location is more flexible. This can be prudent if expanding into a new location.

• Less Up-Front Capital: Traditionally, leasing has required less up-front capital. As stated above, however, this benefit has been muted due to recent aggressive lending practices for medical equipment, which allow some creditworthy owners to obtain 100% financing at historically low interest rates. Additionally, tenants may be required to fund tenant improvement costs, which, in some cases, could be high and, thus, minimize this benefit.

• Ease of Disposition: There are less costs associated with disposition. The tenant can simply end the lease and move out at the end of the lease term.

Cons:

• Lack of Control: A landlord could refuse to renew the tenant’s lease or could lease a nearby space to the tenant’s business competitors.

• Higher Occupancy Cost: Tenants typically have a higher on-going cost of occupancy than owners. At the end of the lease, tenants can face higher rental rates and less lucrative concession packages.

• Inability to Dispose Early: If the tenant desires to move prior to the end of the lease term, there could be costly penalties or even worse, the inability to terminate the lease.

• Lack of Terminal Value: Tenants do not own an asset with value at the end of the lease. 
• As a result, the value of tenant’s lease payments and tenant improvement investments cannot be recaptured once the lease ends.

Home healthcare has several benefits, other than the usual cost, services, and quality. It also allows the patient to have a companion with them, which is one of NORMS’ priorities. Seniors often face the mental challenge of isolation and loneliness, especially when they cannot visit their loved ones frequently. Nurses and caretakers are trained to become a companion for them, comfort them, and help their mental health. NORMS provides all these services for the betterment of your lives at home and making what seems difficult, comfortable and easy