Additional Requirements : Home Care

Version 0.3, Etiene Saliez

As far as possible the goal is to maintain eldelrly persons at home, because it is much better for the comfort of the patient, as well a way to avoid high hospital or institutional costs.
A societal need due to:

Improvement of the life expectancy, which means a larger number of elderly people needing some kinds of assistance.
Changes in family life style. With increased mobility, children do often no more live nearby.

Many elderly persons have various chronic health issues and need some care, but most of the time do not need intensive care really requiring admission in hospital.
Moving the patient to a consultation by the GP and/or in the hospital becomes more difficult and should be avoided when possible.
Typical scenario of elderly care:

Handicapt elderly persons need often help for meals, moving from bed to wheelchair, toilet, cleaning, etc...

Occasionel request for advice by a specialist in hospital.
Sometimes admission in hospital in situations where an useful treatment is possible, for example in order to fix a hip fracture.

The patient can press the button of the bell and someone will come within a few minutes and normally in no more than half an hour.
Anyway someone is entering the room several times a day, as well maybe once during the night.
Up to now few permanent electronic monitoring devices are in use in institutions.

To some extend telecommunication can alleviate the need to move eldrly persons to an institution.

Most generic requirements of the CHOS project apply in case of elderly care. The common standard patient record is here essential since home care require a collaboration between several actors.
Particularly important are the global problem list and the care plan, since elderly persons have multiple chronic problems and need integrated care.
As in other applications of the Virtual Care Team concept, the philosophy is here to share information on-line, available at any time to all the members of the personal Care Team trusted by the patient. A few remainders:

Between GPs and nurses,
Between the members of a team of nurses. Indeed more than one nurse are necessary in order to daily visits 7 days a week.
An emergency call center.

As any other professional partners of the Care Team, nurses seeing the patient daily will of course enter information in the common patient record. As generally required in a shared medical record, the identification and qualification of any responsible author will be recorded and remain visible.
The shared patient record is normally always maintained on a server in the network. However a local backup of the most important data could also be desirable, but only in case of occasional lack of communication with the server.
As in other Care Team implementations, privacy issues relay mainly on the ethic of the small number of actors who are mandated members of the care team of the patient. Normally the recommendation is that all information should be shared inside the Care Team. If necessary a few exceptions could not be excluded.

Home care itself is seen here as one aspect of the global Care Plan.
In case of chronic elderly patients, their Care Plan contains often already several items, e.g. several medications, kine, dietary recommendations, etc... This is here assumed already available and not to be reinvented in a homecare implementation.
Request for home care will appear as a kind of order in the global care plan:

At the same time, as for any other kind of prescription, generation of a formal request for refunding by the Social Security Insurance.

Any new information is primarily recorded in a server in the network, and available at any time for the partners in the care team.
Normally immediately, or as soon as possible whe the connection will become available again.
When appropriate notifications are sent to one or more partners, as a reminder to pay attention to new items in the patient record and immediately relevant to the recipent of the notification. With a priority level to be seen from "urgent", "today", "this week". Urgent notifications could also be sent as SMS.

A permanent connection, although as a mean the traffic is very low.
A presentation of the screen adapted to the need of the patient.
Local wireless connection with diverse sensors, depending of the types of problems of the patient.

The nurses are most of the time moving from one patient's home to the next one, but seldom at the office of the nursing organization.
They need a personal computer with all the usual functionalities including a camera, in principle a kind of light notebook like an "eeePC", easy to carry the bag with the usual medical set, of a nurse or a GP.
Mobile access to internet, inside the home of the patient, but preferently also everywhere, in a car or at the personal home of the careprovider.

The homecare taks should include recurrent reminders asking the GP to review the situation and/or to visit the patient.
Remark: the care team of a patient could include someone from his family, who could also receive notifications and access.

In one way of another someone should pay attention 24 hours a day and be able to decide if urgent measure would be necessary.
Here should this monitoring responsibility be located?

In a nursing station where there is anyhow day and nigth a nurse, i.e. probably in an institution?
In a home care organization having a permanent center, day and night?
In a GP regional call center.
In one way or another someone must be available to drive immediately to the patient.

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Information from sensor are recoded at intervals and remain available on demand as well graphic presentations.
If values are out of expected range warnings need to be generated.