Home based care is seen as a part of nursing profession and medical care. The main target audience of patients consists of those people who have mental, physical, emotional and social needs. The majority of the population are aged people. Chronic illness is the hallmark of aging and the number one health problem for the elderly in the United States. Chronic disorders are difficult to delimit because so many acute disorders have chronic illness and, too often, the results of treating acute disorders is a chronic residual disability. Recently two thirds to three fourths of disabled elders are cared for at home with few or no formal services.
Because the present approach to health care and health emphasizes symptoms and symptom reduction; society is becoming more malignant in terms of environment, diet, and stress inducers ; and health care is becoming economically unavailable to more than 15% of our population, great changes are needed in our philosophy about health and health care. There is a noticeable revival of the American ideal of individualism and self-responsibility with considerable focus on “self-care.” It is suggestive of a system failure and adoption of whatever devices one can muster for self-extrication. We believe deeply in self-responsibility, but, as in every situation, if a similar level of responsibility is not exerted in the metasystem one can hardly be successful within the microsystem.
For example, an individual intent on a healthy diet may find it impossible to find vegetables and fruits free of pesticides, prepared foods free of preservatives, fish free of toxic waste products, and meat and poultry free of hormones and antibiotics (Salzberg, 2002). The impact of chronic illness is also very individual and may include identity erosion, expectations of death, dependency conflicts, and feelings of failure or fatalism or it may mobilize the individual to live life to its fullest. A state of wellness may be achieved and maintained quite consistently during chronic illness if the individual feels capable of and motivated to manage the problems with or without assistance.
The aged or a person with disabilities can be supported toward the achievement of wellness and maximizing their life satisfaction when care givers ascribe to a holistic philosophy that incorporates efforts directed toward the maintenance of the aged person’s self-care and self-esteem. For too long, health care givers have been too naive, unconcerned, or remiss in the maintenance of this important need, which influences so many other equally and more important physiologic, psychologic, and social needs.
It is heartening to note that dental schools include dental care of geriatric patients in their curricula, and students receive practice by going into the community with mobile dental vans to senior centers and to visit homebound and institutionalized elders. Health care providers felt that getting dressed, getting on and off the toilet, preparing meals, and taking baths or showers were the most demanding activities (Salzberg, 2002). Elderly individuals named activities they most avoided because of fear of falling as reaching into cabinets or closets, taking a bath or shower, walking around the house, and getting in and out of bed.
When progress is slow, small signs of progress must be discussed with the individual and frequent encouragement given. Resources should be mobilized for return to the home environment, which is psychologically preferable to convalescence in an extended care facility. Emphasis on the activities the individual desires and is capable of achieving is essential. Given the strong relationship of social supports to recovery, nurses should assist the individual in maintaining existing support systems. The numerous needs of the aged and the special nature of their care requires the most devoted and sophisticated nurses.
Hone based care is not limited only by the expertise and understanding of the nurse and the desires and needs of the client. The logic of home-based care is based on comprehensive understanding and a holistic approach to care, inclusive of the medical aspects of geriatric care and the scientifically based understanding of home-based care.
References
Salzberg, K. (2002). How to Start a Home-Based Pet Care Business (Home-Based Business Series). Globe Pequot; 1st edition.