Home care - an alternative to hospitalisation

Many Singaporeans believe that when one is ill, one can only receive care in the hospital.

However, in recent years, there have been medical groups that offer home care for patients, particularly the elderly with chronic diseases.

One of these is MW Medical's mobiledoctor service, which was founded in 2002 by Dr Madeleine Chew in response to the needs of an ageing population.

"When I first started the mobiledoctor service, home care was not prevalent in Singapore. House calls were conducted with little follow-up and with no multidisciplinary care," she told AsiaOne Health in an e-mail interview. "I felt that the ageing population will require home care where they can have the choice to remain in society while receiving treatment."

Home care is also cheaper and offers more personalised care to individuals as compared to hospital care, said Dr Chew, who explained that it benefits patients by helping them stay active. While patients tend to be less active and communicative when they are hospitalised, home care gives patients the opportunity to receive treatment while staying at home, interacting with family members and doing daily physical activities, said Dr Chew.

In the following Q&A, Dr Chew explains what home care is all about.

1. What is home care?

Home care can be subdivided into chronic care, sub-acute care and acute care.

For chronic home care, caregivers usually undertake a bigger role. They have to take care of medications, daily activities and monitor required vitals such as blood pressure and temperature for patients. Visits by doctors and nurses range between 6 weeks to 3 months. The medical team modifies drug intake, conducts objective tests and advises caregivers on other aspects of care. Nurses also help to change feeding tubes and urinary catheters for patients. Physiotherapists will keep patients active physically.

In sub-acute home care, patients usually have conditions which can be managed with a few hours of daily nursing care such as intravenous therapy or dressing. Medical conditions include community acquired pneumonia, acute flare of diseases like gout, rheumatoid arthritis and urinary tract infection. Doctors visit patients once or twice a week, while relatives or caregivers continue with their daily activities.

In acute home care, patients are very ill and many opt not to be hospitalised so as to be more comfortable at home while they receive appropriate medical care. The team, which consists of nurses, therapists and doctors, provides 24 hour medical attention and care. Caregivers, on the other hand, offer support by providing encouragement to patients.

Suitable for many conditions

2. If an elderly/chronically-ill patient is receiving home care, does it mean that his family members do not need to tend to him anymore?

It does not mean that family members do not need to tend to ill patients when they receive home care. As mentioned above, caregivers provide care of different intensity to patients, depending on their needs.

For example, comfort from caregivers cannot be substituted as patients are attached to them and would like them to be present just to hold their hands at times. Some caregivers opt for home care as they would require a medical team to tend to their loved ones while they are at work in the day.

3. What are the diseases and conditions that make it necessary/advisable for a patient to receive home care?

Many diseases and conditions are suitable for home care. Usually, they are mild to moderate diseases such as mild dehydration, dengue fever and infection, which require a single dose of injection daily. Moreover, these patients tend to prefer to have their independence.

There are also conditions when patients are very ill and are looking for palliative care in their home environment where they are most familiar. These include terminally ill cancer patients and patients at the end-stage of renal or cardiac cases.

4. Under what circumstances is home care not advisable?

Home care does not provide blood transfusions and operations. It is also not suitable for caregivers who are uncomfortable with the concept of having to tend to or witness the demise of their loved ones in a home environment. These caregivers are usually very anxious when they have to tend to their loved ones at home, even with the help of medical team.

5. Why is home care better than staying in a hospital/nursing home?

Home care is a choice made by caregivers. One of the more common examples are of family members who love the patient very much. So much so that they would like to have the patient feel that he / she is wanted at home and want the patient to be able to be near to the family at all times. Home care also reduces the need for additional investigations, usually done in the hospitals, which may not change the conditions of patients. It also keeps patients active physically and mentally as they are in familiar surroundings.

Costs

6. How does the cost compare to staying in a hospital or nursing home?

The cost of home care is not significantly higher. However, patients and caregivers have to pay with their own savings until Ministry of Health permits the use of Medisave for home care.

7. How can one choose home care? Do they need a referral by their GP/hospital?

Any patient or caregiver can contact us at our MW Medical 24-hour hotline 6250 0625. They do not need a referral. Many GPs and hospitals do refer cases to us when their patients are less mobile.

8. Could you share an example of how a patient that you have treated in home care benefited more from this form of treatment than they would have had in a hospital?

Recently, a 50-year-old patient shared with me the reason why he did not want to go to hospital any longer. He had diarrhoea with fever and was admitted to the hospital. He felt better the next day but was told that his salt level was slightly low. He was then put on a drip and was also informed that he needed to undergo a HIV test which shocked the family.

He finally refused the IV drip and sat on the bed for another 48 hours for the diarrhoea to subside. When he contacted MW Medical, he told us that he just wanted to go home and lie on his bed, with no regular vitals taken. He wanted medical treatment without the anxiety and felt he had the right to choose where he is to be treated.

The answers in this Q&A were provided by Dr Madeleine Chew, the founder and managing director of MW Medical.