Home care eases burden on hospital beds

NST: Home nursing is getting popular as patients would rather leave the hospital earlier, writes ANNIE FREEDA CRUEZ.
CHINESE New Year is around the corner but it only brings painful memories for Susan Ngew. It was a terrible occasion for 49-year-old Susan last year when an accident left her with a fractured left leg and a badly smashed right leg.
"My legs were pinned to the bumper of a stationary vehicle when a car rammed into me in Sunway," said Susan, a kindergarten teacher.
"I was rushed to Universiti Hospital by ambulance and later transferred to a private hospital where emergency surgery was done on both my legs," she said.
If the seven-week hospital stay was painful, the mounting medical bill was another headache for Susan.
"I decided to seek home nursing care on the recommendation of my doctor," she said.
It’s not just the financial consideration that both patients and the hospitals, especially public hospitals, look at when they consider home care.
Kuala Lumpur Hospital’s Head of Medicine Department Datuk Dr Jeyaindran Sinnadurai said: "Discharging patients early from hospitals allows the beds to be used for more urgent cases."
The nurse who makes home visits can always refer to the doctor who treated the patient if there are any complications, added Dr Jeyaindran.
"Psychologically, patients also feel better when they are with their family members."
Susan’s decision to seek home care is not an isolated case that goes against the traditional view that patients should only leave hospital when they are completely cured, or that all treatment be given in hospital.
"There are certain treatments that can be done without admission and this will reduce the cost of healthcare," said Tan Sri Dr Ismail Merican, director-general of Health and chairman of the Nursing Board.
Dr Ismail announced recently that by 2010, some 70 per cent of nursing care would be given in homes.
"The trend now is also to promote ambulatory care (for patients who need no longer be confined to bed or who are able and strong enough to walk)."
The ministry, said Dr Ismail, will be introducing several types of home nursing care in stages.
While the authorities are promoting home care, Dr Jeyaindran warned against unscrupulous people, with profit uppermost on their minds, setting up companies to provide substandard services.
"We do not want unqualified people providing home nursing. It can be dangerous."
Dr Jeyaindran said patients who want home nursing must ensure they get qualified nurses and not retired hospital attendants, nursing aides and untrained personnel to give injections and medications, do dressing and provide other services.
"It must not be forgotten that old people who need home care could also be suffering from heart problems, hypertension, diabetes and other health complications.
"They need trained personnel to take care of them."
Consultant urologist Datuk Dr Tan Hui Meng, adjunct professor at University of Malaya’s Faculty of Medicine, said it is important for a patient seeking home nursing to discuss it with his doctor.
As home nursing is a "new" concept in Malaysia, Dr Tan said there should be more home nursing service providers.
"Patients and their families should be given the choice and they should consider factors like quality, reliability, cost and proximity."
Susan arranged for a nurse from the "Nurses At Home" service, operated by Sunmed@Home Sdn Bhd, to come three times a week to dress her wounds from April until last month.
She also visited her doctor during this period and had minor surgery done to her right leg.
An independent study conducted in Malaysia by Nurses At Home shows that as many as 40 per cent of patients in hospitals don’t really need to be there and don’t need the full range of costly and acute services that a hospital provides.
"We’re all aware of escalating healthcare costs and we need to explore ways of coping with this without compromising standards," said Simon Tan, a director at Nurses At Home.
This is care that can be delivered in the comfort of home by a state-registered nurse with a annual practising certificate.
And not all nurses can provide home nursing. For instance, said Tan, a nurse who had worked in the maternity ward may not be be able to deal with aged patients or dress complex diabetic wounds.
Tan, whose company charges between RM65 and RM100 a visit, said: "I must stress that home care does not replace the visits made by the patient’s doctor. We complement the treatment protocols prescribed by the doctor."
Tan said there is a broad range of conditions that can be treated at home but they generally fall under two categories: Rehabilitating patients who can be safely discharged from hospitals to receive home nursing care, and patients needing long-term care, including the aged.
He said one interesting development was that major insurance firms were a lot more receptive to covering home nursing expenses if there was a clear economic advantage and if the service is provided by a reputable firm.
"We have cases where the insurance firms covered home nursing costs beyond the limit stipulated in the policies, including some where no such benefit existed."