Survivor’s Guide to Home Based Care
A rising number of people are choosing the Home Based Care (or HomeCare) option to care for their elderly, frail (due to illness, seizures, heart attacks, major operations, simply old age, etc.) or disabled, family members at home, as opposed to placing them in a frail care center. As long as it is safe, for all parties involved, caring for these frail family members, or aging parents, at home is a praiseworthy and wonderful thing to do.
However, it is vitally important to keep in mind that caring for a frail person in your home comes with many challenges and difficulties. These challenges and difficulties will vary from situation to situation and from the various levels of care that is required.
As a caretaker, you may be responsible for assisting with a variety of activities of daily living (ADLs). You might be responsible for everything from feeding, bathing, dressing, grooming, transferring from bed to wheelchair and back, toileting, basic health monitoring, wound care, aspiration, assisting in oxygen therapy, etc. depending on the situation, and the stage of care that is required.
In many cases of home based care, such as the care of aging parents, you, as caretaker, may have some time to adjust to the varying levels of care, and possibly prepare for higher levels of care that may be required in the short-mid-or-long-term.
Some, however, find themselves in a situation where the care of a loved one suddenly, and unexpectedly, becomes necessary. This is often the case where a major injury was sustained, or by the sudden onset of a life-threatening illness, brain seizure, or heart attack, which may incapacitate the loved one, either temporarily or permanently.
Whatever your case may be, you may take comfort in knowing that there is assistance available to you as a caregiver, both in advice from specialists in the field of frail care and in the variety of frail care products and equipment that can help ease some of the demands of caregiving.
Below we will be discussing various products that may be required for the different levels of care (1).
We also invite you to contact us for a free telephonic or online consultation to receive encouragement, as well as advice, and tailor-made solutions, according to the unique challenges and requirements that your situation demands.
Bedroom
A lot, perhaps even most, of the frail family member’s time, will be spent in the bedroom as mobility becomes more challenging, the ‘patient’ (we’ll refer to these loved ones as patients from here on) tires quicker and requires rest more frequently. In many cases, the bedroom will also be the main center where most of the care is provided, and so the setup in the bedroom should be given special attention based on the specific care required and the level of the frailty of the patient.
Special Beds. Having a hospital bed with various functions such as, being able to move the patient’s back up or down, moving the bed higher or lower, and being equipped with special rails, can ease the burden of care tremendously. There is a great variety of hospital beds available on the market varying in functionality and price.
For those who are unable to purchase a bed, or who realise that the care is only short or medium-term, there are rental options available in the market.
Equip a normal bed for home based care. In the event that having a specialised bed isn’t an option at all, a normal bed can be equipped for special care by, for instance, adding side rails with different functionality to the bed. Also ensure that the height of the bed is comfortable, especially for the caregiver.
Mattress. Whether a hospital bed is acquired or a normal bed is used, the mattress that is to be used must be given serious and special consideration. Where a hospital bed is used, a suitable mattress must be acquired. If a normal bed is used, the current mattress may be suitable as a start, again, depending on the level, and expected duration, of the care required.
The formation of bedsores (2) (often called pressure ulcers or decubitus ulcers) in frail care settings is an unfortunate reality. Fortunately, however, there are mattresses and mattress overlays, such as alternate pressure air mattresses, or “ripple egg box” shaped foam mattresses, available that can help prevent, and treat, all stages of bedsores. Investing in a good pressure care mattress, or overlay can make a world of difference to patient and caregiver alike.
Waterproof sheeting. Many hospital bed mattresses and anti-bedsore overlays, have a water resistant, or waterproof covering, however, not all do and so it will be advisable to add waterproof sheeting over the mattress to protect it from unwanted fluids.
Mobility Aids in Home Based Care
“Moving” on from the bedroom brings us to the very important section of mobility in the home base care arena.
Steps, transfer boards/sheets, and hoists. Where it is at all possible, moving the patient out of bed from time to time is beneficial, and even essential, for the healing and general health of the patient.
Depending on the level of mobility of the patient, special equipment, such as steps, transfer boards/sheets, and perhaps even hoists, may be necessary to assist the patient to get from the bed to his/her feet or wheelchair.
These devices also come in helpful in the event where a patient may have fallen and is struggling to get up, or simply need assistance to move in and out of certain places.
Wheelchairs, walkers, canes, crutches, scooters etc. There is a wide variety of mobility aids available on the market to suit every need and every budget. Finding the correct aid for each unique patient and situation is vital as, for many patients, it may become their permanent mode of primary mobility. If the patient is on medical aid, be sure to contact the medical aid company to find out whether their plan covers the cost of a wheelchair or other mobility device.
Make the house accessible to the level of mobility of the patient and to the mobility device/s in use. Where walkers, canes or crutches are used, adding special rails in the areas where the patient moves, can be very helpful. Additionally, in cases where a patient is wheelchair-bound, ramps may need to be installed in and around the house.
Feeding
Another challenge when it comes to home based care situations is the feeding requirements. Many patients may still be able to feed themselves, but they may require some special utensils and no spill drinking cups. Furthermore, it may often be more practical for these patients to remain in bed when eating, and so an overbed table may be needed. Where a patient is wheelchair-bound, an easily detachable wheelchair tray can be fitted to the wheelchair.
In cases where a patient, needs to be fed, the utensils should again be reconsidered, not only for the ease of use of the caregiver, but for the safety of the patient. In certain cases, the only way to feed a patient is by using feeding tubes and a feeding pump. This is a very sensitive area, however, and it is highly advised that the caregiver consult with a healthcare professional and follow the exact instructions given.
Toileting and bathing
Another sensitive and very personal subject is the bathing and toileting requirements of the patient. Again, as is the case with everything else that is discussed here, every situation requires unique handling depending on the differing levels of mobility, and capabilities of the individual patient.
Diapers. In some cases, patients may need to be permanently on diapers, where they are completely unable to move in and out of bed, or if they suffer from incontinence. Using good quality diapers is of great benefit rather than just buying the cheapest diapers on the market. Higher quality diapers are more effective in absorbing fluids and preventing leaks, so improving the health of the patient, preventing possible cross-infection, and simply making life easier for the caregiver.
Patients who still have the ability to dress themselves can benefit from pull-up diapers, whereas diapers with refastenable Velcro strips can be used in cases where dependence on a caregiver is required. Keeping a good supply of moistened wipes on hand can be very helpful.
Beside toileting. Some patients, on the other hand, may be more mobile and may not require the use of diapers, yet they are not mobile enough to get to the bathroom. In this case bedside toileting equipment, in the form of a bedpan, urinal, or commode may be required. It may be helpful to keep a few plastic vomit bags (emesis bag) handy, as this can greatly reduce spillages as well as the spread of norovirus infections.
Toilet assists. Many, especially among the aging, simply need special devices on and around the toilet to assist them, such as detachable raised toilet seats and grab rails.
Beside bathing. Just as in the case of toileting, it may be necessary to ‘bath’ a patient in bed. A simple basin or bowl, using either a washing sponge, handcloth, or disposable body wipes could be sufficient.
Bathing and showering assists. Where the patient is still able to move or be moved, to the bathroom and bath there, some devices can be helpful in assisting. Grab rails in and around the bath and/or shower is absolutely essential, as well as slip-resistant mats on the floor and in the shower and bath. Bathroom falls and accidents are frequent causes of serious injury, especially among the elderly.
Shower seats. Most frail care professionals will recommend showering over bathing. To assist the patient in the shower, there is a wide variety of shower chairs available. Some of these chairs can be permanently mounted to the shower wall and be flipped up or down as required. Other chairs can be manually moved in or out, whereas some of these chairs can double as a transfer board to assist the patient in and out of the shower.
Bathing seats. Even though showering is highly recommended, some situations may not have that option available. Swivel chairs that can be fitted over the bath’s sides is the recommended aid in these cases, along with enough grab rails and slip-resistant mats.
A quick word about personal Hygiene in Home Based Care
In the previous section we already made mention of hygiene, focusing in on the hygiene of the patient, but it is equally important that the caregiver’s (and others living in the house) health and hygiene be well looked after. It is recommended that you always wear latex, vinyl or nitrile gloves when treating your loved one, whether it be for wound care, bathing, toileting, and even health monitoring.
Furthermore, keeping alcohol spray or alcohol wipes available, and using it frequently to clean surfaces, especially in and around the main care room, will greatly assist in preventing the spread of possible infections.
Specific Healthcare needs
The final main section that we will be looking at is a very wide, yet vital, one. What is laid out here can in no way be considered exhaustive, as the variety of equipment that may be needed to properly look after the healthcare of a frail loved one, is expansive and vary greatly. This list merely gives an idea of some of the basics that may be required in various cases.
Health Monitoring
Keeping a close eye on some of the vital signs is essential in frail care, regardless of the age or level of frailty.
Temperature. The first vital sign to consider is body temperature, as this is often the first way of identifying a possible infection. There is a wide variety of thermometers available ranging from IR ear thermometers, IR non-contact forehead or temple thermometers, up to disposable thermometer strips.
Blood Pressure and heart rate. Another vital sign points directly to the health of the patient’s heart, namely Blood Pressure and heart rate monitoring. Fortunately, we live in an age where digital BP meters and heart rate monitors are easily accessible, inexpensive, and very simple to use.
Blood Oxygen level. The oxygen level in the patient’s blood is of utmost importance. When the level of oxygen in the blood (SPO2) is too low, it simply means that the brain and other vital organs are not getting sufficient oxygen to operate effectively. Here, a small device, called a Pulse Oximeter, can be placed on the patient’s finger to measure the blood oxygen level and give a digital readout. Many Oxygen Concentrators (more on this later) come equipped with a built-in SPO2 meter as well.
Glucose (BG), Haemoglobin (HB), and Cholesterol. In some cases, it may be necessary to measure the BG, HB, and/or Cholesterol level of a patient. There are specialised BG and HB meters available, but also “multi-meters” that can be used to measure any of the three signs using specialised individual strips.
First Aid. Any house should have a well-equipped First Aid kit that is readily accessible in the event of an injury. This holds especially true when caring for a frail family member at home.
Wound care. In ‘post-operative’ cases, or where bedsores may have set in, caring for the wound of the patient is of vital importance. The way the wound care is handled can have a direct effect on the overall well-being of the patient. Ensure that you have proper antiseptics, swabs, and appropriate ointments handy. If necessary, request assistance from a healthcare professional to teach you the basics of wound cleaning, ointment application, and dressing replacements.
“Not all adhesive wound dressings are equal”. People may make the mistake of thinking that “an adhesive wound dressing is an adhesive wound dressing, what difference does it make?”. Well, it may make all the difference in the world, not only for the healing of the patient’s wound/s, but also for the caregiver’s well-being, and the budget of care.
When considering wound dressings look for wound dressings that may be specifically designed for the application needed, that conforms well to the wound area, that will stay on, that is waterproof, and that may require fewer changes. Very often when people buy the cheapest dressings they could find, they quickly regret it, realising that they peel off very quickly (after not conforming well) and that they need to be changed twice or three times as much as a higher quality dressing.
Surgical Suction. Some patients – especially those who had surgery in their mouth or throat, suffer from cancer, or those who simply have dysfunctional swallowing muscles, and are unable, or having difficulty, with phlegm removal or aspirating liquid like blood or pus due to illness, or being in a coma or unconscious state – may require assistance from a surgical suction unit, for nasal, oral, and endotracheal aspiration of these bodily fluids.
Supplementing Oxygen. Earlier mention was made of the importance of maintaining a healthy blood oxygen level to keep the vital organs running effectively. Some cases therefore may require the patient to receive supplemental oxygen, whereas some patients may become completely oxygen-dependent. Oxygen can be administered to the patient either by using an oxygen cylinder, or an Oxygen concentrator.
Nebulizing. Linked to Oxygen supplication, as that may be related to patients suffering from COPD or another type of lung disease, the nebulization of medication, or often just pure saline, may help alleviate symptoms, clear up infections, and ease breathing. Various types of nebulizers are available on the market, and many Oxygen Concentrators even have a nebulizing function included.
Organising medication. The doctor may prescribe a handful of pills and medicines to be taken by the patient. As caregiver you are to ensure that the medication is taken at the correct intervals as prescribed. To assist you in this, there are numerous types and sizes of pill boxes available on the market to choose from that can help with this task, with your smartphone handy for setting medication reminders.
In addition to pill boxes/organisers it may be necessary for you to get a pill crusher (or even medicine dropper), as some patients may not be able to swallow whole pills and so would need to take it mixed in with food.
Monitoring
We all know that it is impossible for anyone to keep an eye on a patient 24 hours each day. You often need to take a break yourself, and you certainly need to get your sleep to prevent exhaustion from setting in, incapacitating you to provide further care. Investing in a monitoring device, of which there are numerous in the market, is the answer to this problem.
Home Based Care during Load Shedding – a unique challenge
Much of the equipment mentioned above (and much of what could not be mentioned), require electricity to operate. With load shedding and power failures, an ever-present and growing, reality in South Africa the homecarer also needs to find a way to provide the needed care to the patient when the power is down.
Some of the equipment does have battery backup options, which one may consider when purchasing. Alternatively, and perhaps a more sustainable option, is to purchase an inverter and batteries (optionally hooked up to solar panels), so that multiple devices can be operated continuously, even during load shedding or power failures.
Conclusion
As has already been mentioned, this list is not meant to be, in any way, exhaustive and a lot more can be added in terms of higher levels of care required. However, this serves to give an overview of some basic equipment that may be required should you wish to opt for the home based care of your loved ones.
We hope that you found this article helpful as a basic ‘survivors guide’ to the home based care of your loved ones. As specialists in the field of frail care solutions, we invite you to contact us for a free consultation to receive encouragement, tips & advice, as well as tailor-made solutions, according to the specific challenges and demands of your unique situation.
(1) In many cases, especially where frail care is required due to illness or accident, doctors and nurses in the primary healthcare facility may advise as to special equipment that may be required to care for the patient. Give special heed to that advice, and ensure that you get as much information as possible from these medical professionals.
(2) https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893