The law of December 23, 1978, established the National Health Service (SSN) in Italy, which is responsible for promoting and guaranteeing medical care for citizens. Over the years, different governments have supplemented and amended this law to ensure better services: these include home care.
The definition of home care can be found in Article 22 of the Prime Minister's Decree of January 12, 2017, which states, " The National Health Service guarantees to people who are not self-sufficient and in fragile conditions, with ongoing pathologies or outcomes of the same, home care pathways consisting of the organized set of medical, rehabilitative, nursing and nursing aid treatments necessary to stabilize the clinical picture, limit functional decline and improve the quality of life."
Home care, why it matters
The changes taking place in the type and distribution of health conditions of the population have an increasing impact on both hospital care and territorial and home care. The change that our country, with the oldest population in Europe, must make is to move from acute care (diseases in the acute phase) to care oriented to the management of chronic conditions of patients at home. Being able to take advantage of medical and nursing care pathways at home is of paramount importance to help manage and support the patient, who can face the discomfort of infirmity more serenely. It is essential to reduce the frequent trips to hospitals for the elderly and frail individuals, which is why it is essential to take all the necessary measures to be able to monitor and manage them at home, guaranteeing them the same level of care they receive in the hospital setting.
The home care system is a way to help patients with their health problems and to help them to cope with their illnesses.
Home care, in its various forms, must provide an effective and efficient care response to the elderly, disabled, chronic, mental health, and patients in need of palliative treatment that can be treated at home. This type of care is provided by the LEAs, Essential Levels of Care, to meet the temporary or protracted health needs of frail citizens, to manage chronic conditions and improve quality of life. LEAs are services that the NHS provides to citizens free of charge or for a co-payment. The services offered by home care can be specialist examinations (physiatric, cardiological, nephrological, etc.), physiotherapy treatment but also more complex services such as the home hospitalization.
The different forms of home care and access to services
.Based on patients' needs, a request for home care can be submitted to the relevant Health Services by the General Practitioner, Hospital Doctor, Social Services, or family members. After the assessment of each case, intervention strategies are defined and, in complex cases, the Multidisciplinary Assessment Unit (UVM) is activated, consisting of a Team with multiple competencies, capable of identifying the needs of patients with complex social-health needs. Having acquired the necessary data, the UVM prepares the Individual Care Plan (IAP) to develop a care pathway that differs from person to person.
There are different types of home care:
- Home care assistance service (SAD); .
- Scheduled home care (ADP);
- Integrated home care (ADI);
- Home hospitalization;
Home Care Assistance Service (SAD)
.This is a service dedicated to people with disabilities with physical, mental or sensory problems whose goal is to help patients with daily activities such as, for example, hygiene of the person and the environment in which he or she lives, dealing with bureaucratic paperwork, accompanying them to medical appointments, or simply as support for relational life. This service can also be requested in a temporary mode to give basic directions to caregivers, such as how to wash a patient in bed, maneuvers for bathing an elderly person, bed-wheelchair movement, or simply to learn the use of medical aids and devices. It can be accessed by request from the patient himself, the family, social workers, or the general practitioner. The service can be free or paid for in accordance with current regulations.
Scheduled Home Care (ADP) and the role of the General Practitioner
Scheduled Home Care is, in general, the responsibility of the General Practitioner and can be offered for a limited time or as long as the patient needs care. National Collective Agreements stipulate that the General Practitioner provides Scheduled Care interventions on a weekly, fortnightly or monthly basis for those unable to walk (nonambulatory) or for the elderly.
Medical activity is aimed at:
- monitor the health status of the assisted person; .
- check personal and environmental hygiene conditions and provide suggestions to the patient and family members;
- give directions to nursing staff, if present, for the correct course of treatment;
- activate, if necessary, rehabilitative interventions;
- give advice for possible dietary treatments.
The physician schedules visits, depending on the needs of the patients, and may be assisted by other services and professionals (e.g., physical therapists, physiatrists, etc.) if necessary.
Integrated Home Care (ADI)
.ADI is a more complex program of care than ADP; in fact, it involves multidisciplinary treatments (medical, nursing, rehabilitation, palliative care, etc.) for patients who need continuity of care and repeated interventions over time. Integrated Home Care can be accessed with a request from the general practitioner or hospital doctor or can be submitted by the patient himself or a family member.
ADI can be activated for:
- acute vascular diseases;
- progressively disabling conditions in elderly patients (e.g., respiratory diseases);
- acute and temporarily disabling diseases;
- severe psychotic disorders;
- severe fractures in elderly patients;
- rehabilitation of neuroleses or vasculopaths;
- terminally ill patients;
- protected discharges from hospital facilities;
Based on the complexity of the pathology, one can distinguish:
- Level 1 and Level 2 ADI, for patients who do not have particularly disabling problems but need care that can be spread over 5 days (Level 1) or 6 days (Level 2). Examples may be people who suffer from chronic nondisabling conditions such as diabetes or liver cirrhosis;
- Level 3 ADI, provided to people with complex conditions that require care scheduled over 7 days as in the case of terminally ill patients or degenerative neurological conditions.
Domestic Hospitalization
Domestic Hospitalization offers the patient hospital care at home. In this case, the patient is followed by the hospital physician. It is a service provided h 24 for individuals with conditions such as: acute heart failure, infections requiring intravenous antibiotic therapy, tumors, blood disorders with a need for transfusion support, acute and advanced chronic neurological conditions. This service also provides, if necessary, devices such as oxygen dispensers or walking aids. Home Hospitalization lasts about 60 days at the end of which Integrated Home Care can be requested.
