Relocating care delivery to the patient’s home offers one of the most promising prospects to enhance treatment while decreasing the overall cost of care. Numerous new and long-standing companies have launched and expanded primary, acute, and palliative care delivery models to the home. Home-based care may prevent the need for more costly hospital or other institutional care for fragile and vulnerable individuals. The potential benefits of home health care in  Barrie care models are enormous, but there are also considerable dangers and problems associated with their widespread implementation. Let’s look at five significant roadblocks to bringing care into the house and see any answers to these issues.

Patients’ choice of places different from their own homes is influenced by many variables. Receiving care at home may serve as a disturbing reminder of one’s disease, as well as an intrusion on one’s personal space. Patients’ perceptions regarding in-home care may be influenced by their previous poor experiences with caregivers or elder abuse and neglect reports. People might appreciate the social component of getting respect and connecting with others, while others may be ashamed of their living circumstances if it’s beyond their comfort zone.

These choices need to be taken into consideration rather than ignored

Patients’ requirements (which may vary from those of family caregivers) must be elicited by physicians. Patients must be included in the decision-making process regarding whether home-based care is the best option for them. Home-based care programmes should also have strong partnerships with outpatient centres, hospitals, and other long-term care institutions to accommodate patients’ shifting preferences and simplify handoffs.

Concerns of doctors. Clinicians may be discouraged from providing home-based treatment because of a variety of obstacles. Taking care of patients at home involves more frequent visits. Therefore the panel size (the number of patients for whom a care team is accountable) is less than at a hospital or office. The typical number of patients that a home-based care clinician sees in a day is between five and seven. 

If home-based care is widely adopted, payment models must reward rather than punish doctors who spend more time organizing and supervising care. Clinicians should be paid on a fee-for-service basis and participate in the savings made by avoiding needless hospital and skilled nursing facility stays. Not unexpectedly, health systems operating under fully-capitated or other risk-based contracts have seen a recent rise in home-based care. Payers must also remove obsolete reimbursement-eligible technology and equipment (e.g., remote patient monitoring, telehealth).

The safety of clinicians is an additional issue

In medically disadvantaged communities, doctors are naturally reluctant to visit patients’ homes because of the high incidence of crime. To attract physicians to home-based care, we must put their safety first. Several examples of health systems train physicians on protocols and de-escalation strategies for home-based treatment and security escorts when required. One of them is the CareMore Health System. Emergency response is readily available to CareMore professionals through the Amaze smartphone app, which home-based care teams utilize.

Finally, there is the issue of medical education. By including home-based care into mandated curriculum and training, medical schools and residency programmes may better prepare the next generation of doctors for this inevitable move away from hospitals. This is a step that some programmes are taking. The Johns Hopkins University School of Medicine’s house-call curriculum for internal medicine residents, for example, boosted residents’ knowledge, abilities, and attitudes toward home-based treatment. Programs like this may help alleviate the scarcity of doctors educated in home-based care and fill up the knowledge gaps in medical education regarding caring for elderly and fragile patients. A whole care ecosystem is required to assist patients at home adequately. For example, CareMore’s home-based care delivery system includes mobile laboratories, mobile radiography, and at-home prescription delivery via a network of suppliers. Home-based care cannot satisfy patients’ demands and provide a full range of services without this assistance. Investing in this infrastructure in conjunction with clinical treatment is a must for health systems.

Patient security is a top priority

Patient safety is particularly jeopardized when care is provided at the patient’s home. For example, environmental dangers such as infection control and sanitation and physical layout can pose problems with caregiver communications and handoffs problems. There is also a dearth of education and training for both patients and family caregivers, making it challenging to balance autonomy and risk.

When bringing care into the house, it’s critical to examine and manage the hazards thoroughly. Every patient contact must take safety into account, including the design of medical equipment and supplies used at home, creating communication tools for home-based care teams, and educating patients, family caregivers, and home-based care professionals. Clinical treatment should take these factors into account. Home safety assessments and suggestions are part of the CareMore home nursing programme, for example.) On a systemic level, we want uniform criteria for assessing home safety and methods for exchanging data and best practices across health care providers.

The environment in which regulations must be followed

As a result, home health care is controlled by a jumble of rules that aren’t often followed consistently. Except for treatment given under the Medicare home health benefit, there are no national or state regulations for the quality of home-based care. In addition, there is very little oversight of home-based care workers’ education, training, and licencing, which puts patients’ safety at risk.

In a nutshell, we must dismantle the fee for service framework and replace it with value-based agreements that incentivize health systems to move treatment back into the home. As a result, incentives for doctors and payers must be coordinated, and risk-based contracts must be implemented to make up for lost income from hospitalizations. We need disruptive new models of care delivery now more than ever, and adjusting the financial and regulatory framework in which health care delivery organizations operate will be critical to their success and expansion in home-based care.

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