Home nursing care: a key geriatric need

Of late, home nursing care is emerging as an important segment of general nursing. Compared to the West however, the concept and practice of home nursing is still in its infancy in India. The concept was till recently alien to the Indian psyche with its close knit communities and joint family system, and the need was never felt for special people to help and nurse their sick and old.

With fast and significant changes in the Indian social and clinical spheres, home nursing is a support system especially in the urban areas, both at the micro level of the patient’s family and the macro level of the over-burdened hospital sector. About 80% of non-emergency medical care now being attended to in hospitals is getting diverted to the home care sector.

It is a multidimensional nursing speciality providing home care to patients of all ages. It includes preventive, rehabilitative and therapeutic care.

Anil Joseph of We Care Health Solutions rightly calls the home nursing care service “a metro city-based business.” With more and more urban men and women in nuclear families going out to work, the elderly are left alone for the rest of the day. Many of them require assistance and post hospital care while others need help in day-to-day personal chores. Busy working schedules of the youngsters and the time-consuming commute to offices further eat into the time they spend at home.

According the Ministry of Statistics, better life and medical facilities have increased the life expectancy of the Indian population, with the above 60 group recording a big jump of 35.5% from 7.6 crores in 2001 to 10.4 crores in 2011 — an all-time high in the percentage of geriatric population growth since 1950 (almost twice the rate at which the general population grew). That this number is expected to more than treble, touching 32.5 crores by 2050, points to the daunting geriatric challenge presented to the Indian society and families alike.

Though home nursing care caters to many areas like post operative, interventional, care of chronic non-communicable diseases not needing hospitalisation, symptom relief, care of children with special needs, chemotherapy etc, it has largely become associated with old-age care, and gets restricted to diabetic care and physiotherapy. This is because day care facilities for the elderly with all their infirmities on a daily basis is much more difficult.

There are said to be around 100 medium and 500-odd small scale agencies offering home nursing care registered in Bengaluru, not to mention the recent entry of the corporate sector in the field, with varied charges, patient-condition being one criterion.

Making it affordable

From 24-, 12- and 6-hourly care and home visits for diaper changing, injections, wound dressings, bladder washes etc, these nurses provide geriatric home care on different levels.

Though home nursing — with its quality skill sets to match the advances in medical treatments — assures significant relief in hospital bills, ward rents and doctor charges for the patient, in cases of inevitable emergency hospitalisation, could add to the financial burden of the family.

With NGOs contributing their might to the service and government offering grants, some regulation on part of the providing agencies should make them affordable to average families, according to the Director, Nursing, of a reputed multi-specialty hospital.

Home nursing personnel are drawn from the following: the six month to one year central government initiated National Rural Health Mission(NRHM) where nurses are initially trained for rural care but many turn towards home nursing, the three-and-a-half year diploma course, General Nursing and Midwifery(GNM which trains in specialised care, the Auxiliary Nurse and Midwife Course(ANM), popular in the 1980s-90s before the Bsc Nursing and the GNM courses emerged) and the Bsc Nursing course.

Middle-aged women trained in old-age homes, too, serve according to patient-needs. However, background verification of the nurses and assessment of the patient family to avoid frictions regarding food habits and safety issues is imperative, which very few agencies undertake.

But Manoj Sreedharan, Director, Medicoshelp Elder Care Service is worried about the widening gap between the supply and demand for these nurses. “We are looking for these personnel in the Northeastern parts of our country as it is difficult to get them from conventional places,” he says. The reasons, he adds, are the availability of better educational facilities, parental apprehension in sending children to unknown homes etc.

Home nursing care is a crucial and developing part of geriatrics, and certainly deserves more attention.