Author suggests that home healthcare is the way forward to improve elderly care and reduce healthcare cost in India

The rapidly growing elderly population is driving the rise in healthcare cost globally. In India, the situation will be no different in the forthcoming years. Given the increase in life expectancy due to medical advances and other factors, India’s 60+ population will grow from 100 million today, to over 300 million by 2050. Out of the 300 million people aged above 60 years, 200 million are likely to be suffering from chronic diseases. The profound shift to chronic conditions such as chronic obstructive pulmonary disease, cardiovascular conditions, endocrinal conditions (diabetes and thyroid disorders), and cancer, directly or indirectly, cause around 50% of all deaths in the Indian subcontinent. This shift to non-communicable diseases will impact the elderly population much more than other age cohorts. This calls for a serious focus on elderly care. This article evaluates the potential of a globally successful care delivery model – “home-based health care” in improving ‘Aging in Place’ and reducing healthcare cost in India.

What is Home Care?

Globally, Home Care has evolved around the idea of providing medical and non-medical services to a person who is ill enough to need care, but stable enough not to have been admitted in a hospital or a long term care facility. These services are delivered to a person in his or her own home. Home Care consists of two broad categories of services:

Home Health Care – medical care provided to individuals in their homes. Trained medical professionals such as doctors and nurses provide these services including, but not limited to, physical therapy, occupational therapy, speech therapy and nursing.

Non-Medical Home care / Personal Care – non-medical home care is typically provided to assist individuals in performing activities of daily living (ADL) in order for them to continue living life from the comfort of their own home. These services are rendered by caregivers but not trained medical professionals. Personal care services include assistance in bathing, eating, mobility, and general household chores such as housekeeping, laundry, shopping for groceries, transportation and preparation of meals.

According to Transparency Market Research’s featured report on global home healthcare market, the home care market will grow at a progressive 8.1% CAGR during 2014 to 2020. This report titled “Global Home Healthcare Market Industry Analysis, Size, Share, Growth, Trends and Forecast, 2014-2020” further states that the global home healthcare market in 2013 was worth US$176,107.9 million, and is estimated to reach a market revenue of US$303,605.9 million by 2020.

“Can Home Care improve the way Indian population ages”?

Patients who are suffering from chronic conditions do not really need to remain in hospitals or long term care facilities. As a result of advances in telecommunications and medical technology, most part of the patient monitoring and care delivery, which was earlier possible only in hospitals, can now be done in a patient’s home. This can result in improved health conditions, reduced hospital re-admissions and lower medical cost for patients. With increase in average life expectancy, homebased care in India is becoming a need rather than a choice.

In developed nations such as United States, Canada and United Kingdom, the concept of Assisted Living Residence or Assisted Living Facility (ALF) for elderly population emerged in 1990s as an eldercare alternative for people who do not need the 24-hour medical care provided by a nursing home and want to live independently with dignity. These facilities provide assistance with activities of daily living (ADLs); coordination of services by outside

health care providers; and monitoring of resident activities to help to ensure their health, safety, and well-being. However, the concept of old-age homes to a large extent is socially unacceptable in India and therefore home healthcare services will become vital in the continuum of care for elderly population in India.

The Road Ahead: Obstacles to Overcome
Role of Technology

The success of Home-based healthcare in improving elderly care, reducing medical costs and improving care outcomes in India is only possible with the effective use of Healthcare Information Technology. From accurate scheduling of caregiver visits to a patient’s home, co-ordination between back office and caregivers in the fields, capturing and documenting patient’s data at the point of care, delivering medical and non-medical services as per the patient’s care plan and standard protocols, patient billing, staff payroll and adhering to regulatory compliances – it requires a robust integrated system to manage every aspect of home care.

Further, the latest advances in IT have the potential to transform home-based care in many ways:

Tele-health applications to connect patients and their families to their health care providers. Such an ecosystem can be very useful in reducing the need of hospitalization and emergency room visits in patients with chronic conditions. Many pilot studies such as asthma Tele-monitoring system and Telematics Management of Insulin-Dependent Diabetes Mellitus have shown promising results.

Web-based social networks have emerged to connect patients with their families, doctors, friends and community for real-time information sharing. These virtual communities of patients with similar conditions can be a very powerful medium of educating, discussing issues, sharing resources and consulting with experts from the comfort of home.

Digital storage and management of personal health records so that patients can increase their health understanding and participate in clinical decision-making.

Personal Emergency Response Services (PERS) – use of Artificial Intelligence and bio-sensors for passive monitoring and management of patients in their homes. Example, wearable medical devices such as wrist bands or neck pendants for fall detection in the elderly people, wearable patch to monitor blood-sugar levels and blood-pressure. These sensors can share the data in real-time and trigger alerts to family members and healthcare providers for immediate medical intervention.

Role of Health Insurance

Unlike developed nations, home care services in India are not covered by health insurance policies. In fact, the overall awareness and adoption of Health Insurance in India is still very low. The Home Care industry has gained a lot of traction in India recently with some domestic and international companies setting up their home health care businesses in metros and other cities. However, increasing the penetration of affordable Health Insurance in India with the coverage of home care services by government and private health insurance plans is imperative to the growth of organized and regulated home care services sector for elderly care in the country. Setting up national and state level regulatory bodies for home care and investments by organized players like big hospitals can bring scale, standards and credibility to this type of care delivery model in India. This would also encourage health insurance companies to cover home care services in their policies.

Undoubtedly, home care led by Healthcare IT, investments from domestic and international players and government initiatives has the power to transform elderly care and reduce medical cost in India in the coming years.

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