Introduction
As we grow older, our bodies become weak, surrounded by multiple age-related diseases or disorders. It becomes extremely difficult to step out or even lift ourselves up for essential activities. Under these circumstances, it is sometimes impossible for an older person to seek medical assistance or visit a hospital for their healthcare needs, and for this very reason, home visits were brought up to help and provide medical services. Domiciliary visits play an important role in geriatric patients who are often associated with various conditions like dementia, heart failure, arthritis, and hip fractures, and there are also patients who fall frequently, have had multiple strokes, or have chronic lung disease requiring oxygen and urinary incontinence.
What Are the Types of Domiciliary Care?
The primary purpose of these domiciliary visits is to monitor the health problems and disease conditions of the patient, to provide the best possible nursing in homely conditions, and to alert the family on immunization, nutritional level, and environmental hazards that are ongoing. There are five types of home visits:
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Palliative: It is a type of specialized medical care designed for people living with chronic illnesses such as cancer, and it mainly focuses on relieving the patient from the symptoms and stress due to the disease.
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Rehabilitative: These services help people to improve the daily functioning skills by exercising, which might have been lost due to sickness or any injury.
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Long-Term Maintenance: These are required for an extended period of time by patients who are recovering from a long-term illness or patients who are blind, deaf, or dumb.
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Therapeutic: This type aims at preventing an illness of the patient by providing physical, emotional, and spiritual support.
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Preventive-Promotive Home Visits: These are the most common types aimed at maintaining the independence of the patient by providing doorstep medical services.
What Are the Things Essential for Domiciliary Visits?
There are certain necessary things to keep in mind before administering an elderly to domiciliary care, such as:
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The private residence of the patient is not provided by the visiting nurse or home health services agency under some health benefits.
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Proper documentation and history of the patient’s medical condition.
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Home health services and services of physicians or non-physician practitioners are performed on the same day.
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No duplicate or overlapping services are provided.
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Reasonable and medically necessary needs for each visit.
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Previous records of physical examinations and diagnostic test results of the patient, if applicable.
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Services that are being provided at home must be of equal quality and similar to services that are provided in offices, clinics or hospitals.
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Proper types of equipment and materials which are sanitized should be available for domiciliary visits.
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The frequency of the visits at home required for any given medical problem will not exceed the number of visits to the office, except on rare occasions.
What Can Lead To Denial of Domiciliary Visits?
A detailed documentation procedure is done before admitting a person in domiciliary to help provide error-free care, and sometimes not fulfilling the criteria can also lead to denial in the admission process, such as:
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The patient’s medical record is not clearly documented, or another clinician is involved during the initial service.
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The frequency of visits exceeds acceptable standards of medical practice.
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The patient is being treated by other providers for the same diagnosis.
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The initial visit and the majority of the subsequent visits are scheduled to coincide with multiple other visits by providers in the same facility without documentation of medical necessity.
What Are the Advantages and Disadvantages of a Domiciliary Visit?
There are numerous advantages and disadvantages of domiciliary care which are described below-
1. Advantages:
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An old person can live independently by receiving home care visits for personal care, household chores, dietary requirements, and medication management.
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Doctors can directly observe the patient in their home and family atmosphere through home visits.
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It is exceptionally beneficial for an older patient who cannot visit a doctor or hospital due to frailty or being bedridden.
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Old age people who live alone and need medical care can benefit from these visits.
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The patient feels more relaxed and comfortable in their home.
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Individual and direct contact generates faith among geriatric patients toward the health care professional.
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The physician can closely observe the care given to the patient by the family members and can also advise them accordingly.
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The chance of having a hospital infection in the patient is reduced.
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These visits can also benefit the patient's family members as they can rely on qualified health professionals and make time for themselves.
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With regard to dental visits, especially for denture wearers, control of oral disease and illness can be strengthened through the organization of affordable oral health services.
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It will help an older person to be more socially connected.
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It is helpful for patients who live alone or have lost a spouse and require emotional support, as they can slip into depression and feel isolated.
2. Disadvantages:
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There is more time and effort needed for in-home visits.
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It is not possible to provide complete and extensive services at home.
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There may be chances of conflict in the choice of treatment between the patient’s family members and the health care professional, which may make the guidance and suggestions difficult.
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It can become lonely for the patient who lives alone as it depends on the amount of care or visits the patient gets throughout the day.
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Some patients may be resistant to having unknown people at home.
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Treatment in care homes can be complicated due to difficulties with communication and cooperation with the patient.
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In dental care visits, there can be constraints due to patient positioning and access to the mouth.
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Cultural differences between the care and the patient’s family can exist due to different backgrounds.
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It is challenging to treat older adults physically and emotionally at home who are mentally ill.
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Sometimes, the choice of a patient’s caregiver with whom they have developed a long and strong bond may not be available.
Conclusion:
Even with minor challenges, it is essential to consider the impact of domiciliary visits on the older aged person to explore the issues of access to medical care by determining the safety of domiciliary care and discussing it for the risk assessment for the patient.
