Post-treatment care: in-patient vs home

Healthcare in India is growing at a remarkable pace with a slew of investments pouring in from different parts of the world into multiple sectors. With the country evolving to be a promising land of opportunities for personalised medicine, medical devices industry and diagnostics, there are reasons to cheer for every citizen.

Our hospitals boast of state-of-the-art infrastructure and offer world class treatments to patients from far and wide. Innovative startups in mobile technology and improved data services have further enhanced the prospects of healthcare. Unfortunately, even as we proudly compare the healthcare services of India with the developed economies of the world, we tend to overlook a critical vertical in healthcare — post acute care.

Post acute care refers to the intense inpatient care required by an individual after undergoing critical treatments/ surgeries in acute care hospitals. Soon after a patient is declared stable, hospitals prefer to discharge him/her to offer the bed to another individual who is in need of critical care. However, at this point, the patient needn’t be fully ready to go home and get back to his normal life.

If the individual is recovering from an unanticipated critical illness like a stroke, cardiac arrest or neurological disorder, he/she will need the support of transition care, before being shifted to his/her house. Transition care comprises rehabilitation services which are designed by a multidisciplinary team of doctors to help the individual regain strength and functional abilities, leading to an accelerated and enhanced recovery.

Most developed nations give great emphasis to transition care in order to reduce re-admissions in hospitals following deterioration of health, assist patients in resuming self-care at the earliest and reduce the overall expenditure of hospital stay. However, in India, post hospitalisation care is often confused with home-healthcare and patients are directly shifted to their homes.

In the absence of continued monitoring by a team of doctors and skilled nurses within an in-patient facility, patients recovering from trauma related to neurology, cardiology, orthopaedics and oncology could go to relapse and, in worse cases, deteriorate into a ‘vegetative’ stage. So, it is important for a patient recovering from such traumatic conditions to receive transition care before being shifted to home care settings.

Multidisciplinary care providers

There are several disparities in care between the two kinds of care. Inpatient rehabilitation centres, unlike home care providers, offer specialised care which is supervised and monitored by quality standards and safety norms, and administered by a skilled team of rehab professionals. While home care is effective with the intermittent and mono-disciplinary needs of a patient through a one-time visit of the doctor, nurse or physiotherapist, a specialised rehabilitation centre serves the continuous and multidisciplinary needs of a patient through the collaborative approach of a group of care providers.

These include physicians, nurses, physiotherapists, dietitians, counsellors, speech therapists, occupational therapists, respiratory therapists etc. With the involvement of multiple care providers in the recovery process, any medical emergency is predicted and handled better.

In order to ensure a seamless transition of care from a critical care hospital, the involvement of a primary physician is very important. Rehab centres recognise this and involve a primary physician in care. While the family member or patient will have a greater role in driving the care plan (example, the duration of a physio session could be altered) in home care, rehabilitation care is led by a ‘care team’ keeping in mind what works best for the individual’s holistic recovery.

Scope of health education, group therapy (motivation and socialisation), development of functional and cognitive abilities through equipment and institutional set-up, constant monitoring of performance indicators etc provided at rehabilitation centres make it an ideal setting for empowered recuperation.

A patient transitioning from acute care should choose the next care setting depending on his/her individual requirement. Home healthcare should be chosen as an economical option for a patient who is in need of only one service (nursing care or physio). But if he/she is recovering from an acute traumatic condition and requires a bundle of services, it is important to seek help from an inpatient rehabilitation facility. With the cost of stay in a rehab facility being one-third of a hospital’s critical care package, it is in the best interest of a patient’s health.

Developing an acute care strategy will significantly level the wide existing need gap in India’s current healthcare scene by completing the care continuum.

(The writer is Director – New Initiatives, SuVitas Holistic Healthcare)