English

Concept of home care in the Czech Republic and rules for delivering home care services (Translation of the informative material of the National Center of Home Care of the Czech Republic)

Q: What is the purpose of home care? What is the role of home care in the system of health and social care?

A: Home care works in the framework of primary care, in the normal social environment of clients, and it strives to provide maximum extent and quality of health and social care, with regard to the particular client's conditions and in line with the recent scientific research, so as to avoid the patient's hospitalisation or admission to a social care institute unless it is absolutely necessary .

Q: What does 'primary care' mean?

A: Primary care is a complex of health, social, and lay activities provided to the needy clients within their community and in the first-line contact.

The said complex of activities, or the 'primary care', is closely related to promotion and protection of health, health prevention, medical examination, treatment, nursing, rehabilitation, and social services, including promotion of such conditions that will, within the community, ensure maximum quality of life to citizens of all age groups and various diagnoses or indication related groups.

Modern approaches to health and social care systems are based on the principle of subsidiarity. Subsidiarity means that treatment, care and help come from the closest possible level. Subsidiarity requires active participation of the client and his family or friends in the process of decision-making and problem-solving as well as in the delivery of care. In short, clients are helped to help themselves. The client and his family or friends are actively engaged in decision-making and participate in delivering the care.

Q: What can I expect from Home Care?

A: Home care is a combination of health and social (sometimes referred to as Home Help) care, including lay care provided to the needy client in line with his/her physician's recommendation in his/her own social environment.

A needy citizen, as defined for the needs of home care, is a person who, due to changed health or social status, depends fully or partially on professional assistance of another person. Home care is a highly qualified and specialised form of care, which is of such extent and quality that it allows for reducing of the clients' stay in an inpatient medical facility to the shortest possible time.

Besides, home care helps general practitioners create conditions for the primary care to make use of home care agencies and provide wider range of services to clients who would otherwise have to be hospitalised.

Q: What do 'home care' and 'home help' mean?

A: 'Home care' covers a wide range of services including activities of medical nature as well as social assistance (sometimes referred to as home help).

Q: What are the advantages of home care?

A: Home care respects the client's integrity, social environment and understanding of the quality of life. Therefore, each client is individually assessed from the bio- psycho- social point of view, and home care is always based on the so-called holistic approach.

Scientific research has proven that one's good mental condition, which benefits from home environment and proximity of one's nearest, which are essential to home care, have immediate impact on one's immune system and play an indispensable role in the process of recovery, or in diminution of the negative influence of the psychological symptoms accompanying almost all forms of diseases.

The role of client and his nearest in the process of delivering home care is indispensable. In the framework of home care, the client and his/her nearest are members of a team with a common purpose, i.e. improvement of quality of life of the client and his nearest. This, again, is a unique advantage of the Home Care system.

Another advantage is total elimination of nosocomial infections . Nosocomial infections are a result of treatment in medical facilities. Financial expenditures related to treatment of the nosocomial infections are so high that all modern systems of health care strive to minimize the stay of clients in medical facilities.

Q: What are the material, technical, and personal preconditions for delivering home care?

A: Development of new technologies for diagnosing and therapy, as well as the offer of pharmaceutical products, enhance wider applicability and higher quality of modern home care. Good home care agencies are equipped with technology that not only ensures timely diagnosis and therapy, but at the same time, helps increase comfort of the provided home care. In order to do so, home care agencies rent various compensatory aids and smart beds. Miniaturization of diagnostic equipment and reliability of disposable medical tools and drugs, however, are not the only precondition for providing high quality home care.

Another important precondition for delivery of high quality home care is the working experience and a functioning system of continual training of the medical staff who are trained to cope safely and reliably with both health and social problems of their clients within their own social environment.

The valid legal regulations require that the professional home care agency staff have at least five years of working experience in the relevant field, out of which at least 2 years are at the bed-side. These criteria of working experience are the strictest in the health care system. The reason for such strict criteria is the fact the caregivers working in the system of home care need sufficient know-how, skills and experience to be able to respond accurately to changes in their clients' health condition.

Q: Is delivery of home care addressed by law?

A: Since 1992, delivery of home care has been addressed by a number of legal regulations, which define the spectrum of clients, the conditions for delivery, the extent of care, and the qualifications of caregivers. Valid legal regulations related to home care are issued by the relevant ministries.

E. g. home health care is defined in the Law on Public Health Insurance in the valid wording - Act no. 48/ 1997 Col. on Public Health Insurance. The ways of reimbursement and the cost limits of home care are addressed in the List of Diagnostic and Therapeutic Acts - Decree of the Ministry of Health Care 134/1998 Col. in the valid wording.

Qualifications and responsibilities of the professional team members (Acts nos. 95 and 96/2004 Col., and Decree of the Ministry of Health Care 424/2004 Col., on Responsibilities of the Non-Medical Staff) as well as the required equipment of home care agencies are defined by valid legal regulations (Decree no. 49/1993 Col.), which stipulate for detailed material and technical equipment of the agencies, as well as for the criteria of professional qualifications of the caregivers. Social care, which is delivered as a part of home care, is addressed by the valid wording of the legal regulation stipulating for delivery of social care and assistance (Decree 182/1991 Col., in the valid wording).

Obviously, the number of legal regulations dealing separately with different aspects of the clients' health and social condition leads to misconceptions. In practice, what is most frequently called 'home care' (see 'Outline of Home Care' - issued by the Ministry of Health Care in 2004 as a Recommendation of the Ministry of Health Care) can be hidden under various 'tags'

One of such tags is the 'home health care'. This descriptive notion is frequently used in legal regulations addressing delivery of health care.

Health and social care agencies applying for registration with local governments, and community politicians and political parties or movements introducing their agenda often use term 'complex home care'. This notion reflects the need to provide solution to a wider range of inter-related health and social problems. 'Complex home care' will certainly soon make home in the wording of valid legal regulations.

Another notion that is used, though, in this case, incorrectly, is 'home nursing care'. The notion is incorrect as it reflects misconception of the very philosophy and nature of home care. Home care, just like hospitalisation of a client or care in an inpatient medical facility, is based on close team cooperation between physicians, nurses, physiotherapists, logopedists (speechtherapists), psychologists, other professionals in the field of health and social care on the one hand, and the client and his family or friends on the other hand. Each member of the team is indispensable and his/her responsibilities result from his/her qualifications and the length of working experience.

Notions such as 'field nursing care', 'family nurse', or 'home nurse' are, again, used incorrectly and should not occur in the valid legal regulations. Using these notions is misleading and causes misconceptions on the side of lay public.

Q: Who can benefit from home care?

A: It can be you, your family or friends or just anybody, whose health condition has changed so that it cannot be managed by lay care and that it requires professional medical care.

Home care can be indicated for example after an uncomplicated surgery or when your health condition during hospitalisation gets satisfactory and allows for discharge from the inpatient medical facility but when, post-acute medical care in your own social environment remains necessary.

In both cases, home care needs to be indicated by your physician, who can best assess your overall health condition. Home care is provided to all age, indication and diagnosis related groups of clients; it can be delivered to children as well as to middle-aged people or to the elderly.

Q: What are the most common indication related groups of home care clients?

A: Physicians most often indicate home care to those clients who are fully or partially dependant on another person's assistance, who need to be given continued long-term or post-acute care, or rehabilitation. Home care activities also include caring about mental health and re-socialization of clients suffering from mental disorders.

The system of home care provides flexible and variable solutions to the client's problem and it is able to respond to the individual client' s needs and to the responsible physician's indications.

Q: What are the forms of home care?

A:

Home hospitalisation:

A part of home care is specialized care about clients after surgery or after trauma. This form of home care is also suitable for clients with cardiovascular or neurological disease, including immunodeficiency. Children form a specific group that, compared to the other age groups, shows even faster recovery if provided with home care. This form of home care is provided for several days or weeks.

Examples of home hospitalisation.

• Post-surgery care

Outpatient Surgery (or One Day Surgery) is a pre-planned surgical treatment which replaces post-surgery inpatient treatment with home care. It is not a new medical method. What is new is the organization of the post-surgery care. The patient is not admitted to an inpatient ward and therefore, he/she avoids the risk of hospital infection. The treatment can be carried out by a hospital, an outpatient clinic, or another specialized facility.

Well-organized home care which takes over the patient right after the one day surgery, results in faster recovery, reduced expenditures on health care, and faster re-activization of clients leading to faster resuming of work, which in turn reduces the expenditures on sick leave pay. High professional quality of nurses, rehabilitation staff and physicians as well as good and well-targeted education of clients and their family or friends are the basic precondition of home hospitalisation, which, of course, has to be equal to the adequate hospital care.

Post-traumatic care.

Post-traumatic patients, if fully conscious and if not in risk of serious complications, can be safely treated in home care. These clients usually need to be given pain-killing treatment, positioning, dietary, hydratation and hygiene regime, professional treatment of injuries and wounds, continual physiotherapy. Home care agencies are equipped with specialized aids that allow even for long-term posttraumatic treatment of clients in their own social environment.

Long-term home care.

Long-term home care is provided to chronically ill patients, whose physical and mental condition require long-term home care delivered on regular basis by qualified staff. Usually, it is provided to clients after stroke, with multiple sclerosis, complicated diabetes, clients with partial or complete paralysis, or clients with serious mental disorders, immunodeficiency or chronic pain.

This form of home care consists of activities of both medical and social nature. It is a so called integrated form of home care, or a comprehensive (complex) home care, and it can be provided for months or even years.

Examples of long-term home care.

• Pulmonary diseases

Chronic pulmonary diseases can result in partial dependency on ventilators, supply of oxygen from oxygen bombs and oxygenerators. In home care, the main responsibility and know-how about the treatment stays with a well-trained client. The home care team and the GP only educate, inform, and support the client. Treatment at home is obviously cheaper and nicer for the client.

• Diseases of the digestive system.

Professional intervention concerns mainly stomies and cases of large intestinal resections, and intravenous, or alternatively another form of nutrition, which is delivered by a home care agency nurse. Medical issues are addressed by the client's GP or by a visiting surgeon or gastroenterologist.

• Metabolic diseases.

Teaching children suffering from diabetes mellitus typ I how to apply insuline, if it does not exceed 2 weeks, can be provided by home care, as it is an integral part of the tasks performed by specialty 925. Home care also takes over the clients suffering from diabetes mellitus II., who are for medical reasons fully or partially dependent on professional care (clients whose diabetes mellitus II complications have led to amputations, loss of sight, orientation impairment etc.) Possibly, other metabolic diseases can be included, if it is necessary to provide pain management or hydratation of the client's organism, including removal of metabolites from the client's blood (peritoneal dialysis).

• Neurology diseases, degenerative diseases of the central neural system.

The list will not be complete if we do not mention home care in neurology patients. Care about clients after stroke (ictus) or suffering from Parkinson´s disease, Alzheimer´s disease, sclerosis multiplex, syringomyelia, paraplegia, or quadruplegia and others is provided very frequently and it is a part of the very basic spectrum of the diagnosis and indication related groups of all GPs and home care agencies. Caring about neurology patients is usualy time consuming and it needs to be delivered by the whole home care team together with the client's GP and family or friends.

• Oncology diseases.

Many oncology diseases require administration of pain-killers and creating such environment that will minimise stress and risk of infection, as the immune system of clients undergoing chemotherapy is weakened. Regardless of the disease prognosis, longer stays in hospitals usually have negative impact on the clients' mental state. In close cooperation with oncologists and GPs, we can provide treatment and nursing of oncology patients at home.

In some cases, chemotherapy can be performed and supervised by outpatient oncology units, while administration of drugs or procedures reducing pain are indicated by a GP. In line with the GP's indication, pain management is in turn performed by home care agency staff. It is evident that this combination of outpatient treatment and home care have positive impact on the clients'overall condition and on the prognosis of their disease. Besides, this arrangement significantly reduces expenditures as the patient is not hospitalized and he/she spends less time on sick leave.

• Mental disorders.

Monitoring of clients suffering from mental disorders, drug administration, activization, re-socialization, info reporting and education of their family or friends is an inseparable part of home care. With adequate extent and quality of home care, clients with mental disorders rarely decompensate. The clients' condition needs to be monitored on regular basis. If the client's mental or social condition changes, the information is reported immediately to his/her psychiatrist and the situation is solved with no delay, which helps increase the quality of life in this diagnosis related group, their family and friends.

Preventive home care.

Preventive home care is provided to all groups of clients that have been recommended by their physician for preventive monitoring of physical or mental health on regular basis. Home care staff performs measuring of physiology functions, monitor the overall state of the client and report changes immediately to the relevant physician. This form of home care is provided on weekly or monthly basis, in line with the recommendation of the client's physician.

Examples of preventive home care.

Home care is suitable mainly for tertiary prevention, which strives to prevent complications in the already existing diseases. It may consist of, for example, regular general check-up and measuring of physiology functions in clients (fully or partially dependant on another person's assisstence) suffering from cardiovascular disease, intake of biological material in clients suffering from metabolic disorders, monitoring of the process of re-socialization and compenzation in clients suffering from mental disorders.

Within community, it is possible to use the system of home care for secondary prevention - i.e. detection of early phases of diseases by means of screening.

Primary prevention is an inseparable part of the civic activities carried out by the home care staff who often use their free time to give lectures on preventive programes in the field of infectious diseases, AIDS prevention, issues related to family planning, past time activities - quality of life, partnership, addictions, or the role of client and his family or friends in looking after the client's health.

Home hospic care.

Home hospic care is provided to clients who are terminally ill. The final part of life, dying, is the hardest part of human life. Dying is a process, which has several phases and which is accompanied by a number of symptoms that effect the client and his family or friends. Home hospic care is usually provided to clients who are supposed to die within six months. Home care staff should provide professional care including pain management and emotional support and reduce the suffering of the dying client as well as his/her family or friends. Home hospic care is usually indicated in the frequency of up to 3 visits per day. The frequency of visits can be even higher, provided that the relevant physician submits a written application and the application is approved by the health insurance company physician.

Examples of care about the terminally ill.

Looking after a dying person is very demanding for all home care team members. Usually, it involves GPs and the whole home care team, including volunteers. The client is given professional care, with respect to the situation in his/her social environment or family and to his/her need, several times per day or permanently. The purpose of home hospic care in the first place is to reduce physical and mental suffering of the dying person and his/her family or friends, and to eliminate what is called 'social death'.

In order to achieve the purpose, if the client agrees, home care staff makes use of a number of advanced pharmacological and psychological methods of reducing pain. Difficulties related to administration of food and drink are usually resolved by means of intravenous hydratation, or by a nasogastric tube. Supply of oxygen is provided by means of oxygenotherapy. The meaning of home care in case of the terminally ill is not primarily in its cost-effectiveness but in humanization of the hardest moments in each person's life.

Q: What is the 'natural social environment'?

A: Home care is not always provided in the client's own home. It can be given the client's relatives' or friends' homes or in a facility that permanently substitutes the client's home, such as senior institute (sheltered housing) or an institute of social care.

'Natural social environment' can by no means be represented by a temporary facility, such as day center, spa, hostel etc.

Q: Who is my 'relevant physician'?

A: As far as indication of home care is concerned, the 'relevant physician' is usually a general practitioner for adults or a general practitioner for children and youths, i.e. physicians who work within the primary care.

Home care can also be indicated by a specialist who looks after you in hospital. However, such home care can last only up to 14 days after you have been discharged from an inpatient facility. In this case, it is a physician who works within secondary and tertiary medical care.

Q: What is the correct procedure of indication - prescription of home care?

A: The relevant physician estimates the client's overall health condition and the state of the client's social environment, and in cooperation with a selected home care agency fills out a voucher for specialty no. 925 (home health care) on Form no. 06 with sequel no.1. The Form is filled out, including all the required health information about the client and the degree of his/her mobility, and supplemented with other required data and forms. The type of visit is specified on Form no. 06. So far, home health care recognizes four types of visits, distinguished by length - 15, 30, 45 or 60 minutes.

The relevant physician fills out the type of visit and briefly describes the services that should be performed during the visit. In case of services that require use of material, it is necessary to specify the code number of the material in question. Material code numbers are based on average material expenditures necessary for performing the relevant task. Local healing substances or other material equipment or aids that a particular client momentarily needs, are considered by the relevant physician. These products are prescribed on the recepe or on a special voucher, and the physician keeps record of these on Form no. 06. Physicians and home care agencies agree on an interval of submitting a brief written report - summary. The summary is written by the agency and it informs the relevant physician about the developments of the client's health condition. Deadline for submitting the summary is specified in Form no. 06.

The relevant physician keeps one copy of the Form no. 06 in his/her files, the original goes to the selected home care agency. Indication of home care prescribed by GPs for adults or by GPs for children and youths in Form no. 06 is valid for up to 1 month.

When the one-month's home care cycle elapses, GP may decide that home care should continue in an unchanged form. In that case, he/she fills out only the head of Form no. 06, marks the form with a sequel number ( 2, 3, 4 ...to x), and concludes by writing down that:

"Examination performed by the responsible physician on .... has shown that the client's health condition has not changed. Therefore, we suggest that home health care continues to be delivered in the previously defined extent, see Form no. 06 sequel x ".

Home health care is not limited in time. It can last for weeks, months or years. If the client needs it and the relevant physician indicates it, it can be provided continuously.

Medical specialists who discharge a client from an inpatient facility or after one day surgery, can indicate home care for up to 14 days. In this case, home care is commenced on the very day of the client's discharge. With regard to the needs of reimbursement from the fund of health insurance, the first and the last day of the clients' hospitalization are perceived as "half-days".

During the home care cycle specified in Form no. 06, the medical specialist who indicates home care is bound to submit a written report on the client's overall health condition, indication of home care, prescription of drugs, aids and other products to the client's GP who then decides whether home care will or will not be continued.

Within 1 month or 14 days the client's health condition can dramatically change. Therefore, it is necessary that the home care agency observes the client's overall condition on regular basis and informs the relevant physician with no delay in case of changes. The physician visits the client and decides whether the extent or frequency of home care require modification. The visit and possible modifications are reported in the physician's files and a new Form no. 06 is filled-out, specifying the modified extent of home care.

In case of acute changes found in the client's overall health condition, home care agency is obliged to ensure adequate medical care, otherwise the requirement of obligatory care would be offended.

Q: What is the frequency of home care?

A: Maximum frequency of home care, if it is to be covered by health insurance, is one hour of professional care three times a day. This time limit is sufficient and it allows caregivers to cope even with very serious health conditions of their clients'.

If you or any of your relatives or friends have experienced hospitalization, you may know how much (or little) time per day you spent with the professional staff.

This may help you understand that home care staff have sufficient time to deliver maximum extent and quality of professional care. Still, should the client's health condition require greater extent or frequency of home care, it is possible to apply in writing for increased home health care funding, and if approved by the health insurance company physician, home care can be extended up to 5 hours a day. The process of application approval is strictly individual and for ethical reasons it results in positive decision mainly in case of dying patients requiring pain management.

Q: What are the working hours in home care?

A: Given the diagnosis and indication related groups of clients in home health care (clients are fully or partially dependant on another person's assisstence; some patients are terminally ill) it is necassary to ensure non-stop accessibility of care 24 hours a day, 365 days a year. However, this does not equal non-stop working hours!

Accessibility of home health care is usually ensured by an emergency phone line, which can be used by the relevant physician, the client and his/her family or friends in case of need any time a day. Emergency line is a mobile line and the number is given e. g. on the answering machine of the home care agency fixed telephone line. The home care agency team members pass on the emergency mobile phone as they take turns on duty. The person on duty is obliged to ensure care or other assisstence as necessary.

Q: Who delivers home care?

A: Home health care is delivered by a multidisciplinary team, whose members deliver care (professional and specilized) and help (lay) to the extent that is necessary with regard to the client's and his/her social environment momentary condition. Home care is delivered on high professional level and the team consists of qualified and well-experienced members - physicians, nurses, physiotherapists, psychologists, logopedists (speechtherapeutists), social workers etc .

The team is coordinated by the home care agency dispatching centre. High quality home care agencies have well-established organizational and operational rules. The agency dispatch centre serves also to the purpose of info transmission to the relevant physicians and clients, as it takes in questions, requirements and suggestions.

Coordinators at the dispatching center in cooperation with field workers are able to ensure immediate commencement, modification or extension of any particular client's home care.

Each client has his stable care manager. It can be a nurse, a physiotherapist or another team member who is responsible for quality and accessibility of home care. The care manager is in continual contact with the client and he is accountable for compliance with the time schedule and organization of home care as indicated by the client's physician. In agreed intervals, he/she submits reports about the client's overall health condition to the relevant physician and if necessary, he/she suggests modifications in the extent of home care.

Home care is also delivered by the client's relatives and by the client him/herself, as they perform an agreed extent of home care and help.

Q: To what extent is home care covered by health insurance?

A: Health insurance as provided by health insurance companies covers such home care services which have been indicated by the relevant physician and which are of medical nature. Namely, these are specialized and professional services performed by qualified medical staff. A list of these tasks can be found in the List of diagnostic and therapeutical acts and their value (expressed in points).

The home care system may be represented by various forms of medical care:

• Nursing care, defined by responsibilities of a general nurse, pediatric nurse, mid-wife, nurse specialized in a particular specialty (f.e. care of stomy).
• Rehabilitation care, defined by responsibilities of a physiotherapist or ergotherapist (occupational therapeutist).
• Care, therapy and consiliary advice provided in response to the client's momentary health and mental condition by relevant physicians of different medical specialties - GP for adults, GP for children and youths, outpatient specialists.
• Care provided by other medical staff, such as hospital psychologists, logopedists (speechtherapeutists) and others.

Q: How is home care commenced?

A: Once home care has been indicated by a relevant physician, a home care worker visits the client and performs an initial interview, examination and assessment of the client's social environment. The worker explains the extent and frequency of the care to be delivered, agrees on a time schedule of both professional and lay care to be delivered by the agency, the client's family or friends, and the client him/herself.

In order to achieve high quality of home care, it may be necassary to make changes in the client's natural social environment, such as changing position of his/her bed, provide aids or other equipment etc. Such changes are made upon agreement with the client and should reflect not only technical needs of home care but also comfort of the client.

In case home care has been indicated during the client's hospitalization or after a one day surgery, it is desirable to make first contact with the client when still in an inpatient facility, so that the home care worker can discuss further arrangement with the relevant physicians and staff. Home care is usually commenced on the next day after the client's discharge or immediately after one day surgery.

Q: What is the maximum extent of social assisstence provided in the framework of home care?

A: In the framework of home care, social assisstence is delivered by the Home Help. Home Help is provided, organized, and ensured by agencies of public administration or local governments to seriously handicapped citizens who are not able to perform the necessary housework and other life necessities, or whose adverse condition requires another person's care, or other personal care, provided that such care cannot be delivered by family members.

Pursuant to the valid legal regulations, Home Help is fully or partially reimbursed by the client, with regard to the client's age, health condition, income, and financial situation of the client or his/her family. To provide Home Help, public administration and local governments use their own facilities, or they annually alot certain amount of money in their budget for facilities that are contracted to provide Home Help. Such facilities may include home care agencies, which, on contract with public administration or local government, deliver comprehensive, complex (i.e. both health and social) care to clients with serious health impairment. The degree of the client's social disadvantage is assessed by a social worker, who then determines the extent of Home Help. The social worker also specifies the amount by which the client will participate in reimbursement of Home Help, as stipulated by valid legal regulations.

In the framework of home care, socially disadvantaged clients are most frequently given the following types of social help: simple nursing tasks, pedicure, massage, haircut or hair styling, dressing aid, help with getting on a wheel chair, to the toilette, on bed, delivery of drugs, food and beverages, making breakfast, snack, lunch, dinner, help with serving food and drink, tidying up, house chores, washing, ironing and minor mending of clothes, accompanying to a doctor, shopping, running errands.

Social help services, which ensure basic living necessities of socially disadvantaged clients, such as complete bathing including washing hair, are provided free of charge, i. e. without the client's participation on reimbursement.

Q: Is it possible to provide non-standard top-up services in the framework of home care?

A: If the client is not entitled to Home Help as a "socially disadvantaged citizen", all the social help services, including haircut, pedicure, manicure etc., have to be paid directly by the client (the price reflects the overall expenditures related to the particular service). Ordering wider extent or higher frequency of home health care than the client's health insurance is willing to reimburse is another example of top-up service. Should this situation arise, it is necessary to inform the relevant physician, who´needs to decide whether the ordered top-up home care complies with the client's condition.

Every time the client orders top-up services, he/she is informed about the way of calculation and the total price to be paid. Then, the agency signs a written contract on provision of top-up services, which, besides other obligatory clauses, includes a detailed list and extent of the services in question, including the price and the total amount to be paid by the client, as well as the deadline for paying. The contract is signed by the client or his/her legal representative and by the statutory representative of the home care agency.

Q: How is home care integrated in the network of the other forms of medical and social care?

A: Home care has to be accessible 24 hours a day, 7 days a week. Besides, safe and high quality home care has to be integrated in the network of other forms of care and help.

At the very beginning of providing home care, the client and his/her family or friends are given telephone numbers and addresses to be contacted in case the client's health condition should change. Home care agency provides its clients with an emergency line phone number to call in order to obtain immediate post-acute medical help.

During working days, home health care is directly supplemented with care of the relevant physician (a GP or a medical specialist - up to 14 days after the client's discharge from hospital or after a one day surgery) or the client's social worker.

At night or on non-working days, home care ensures contact with the relevant physician. Should the relevant physician not be available, the responsibility goes to the emergency services.

Q: What records are kept and filed about home care?

A: Home care agencies are obliged to keep interim records about commencement, course, and completion of home care. The records include information about the client's overall health condition, its changes, performed and planed services and other facts that are important for a possible quality, extent and professional accuracy control.

The file has to be clear and accessible to other providers of medical care who participate in compenzation of the client's condition, which is why it should be placed on a visible place.

If it is not possible, it is necessary to give the client, or his family or friends a contact (cell number, address) to the last caregiver so that the next person to see the client can reach information about recent services performed by the agency.

Quality, clarity and accuracy of records, as well as their accessibility to all members of the home care team, including the providers of follow-up care, are often essential for determination of further curing and nursing interventions, which, in case of acute changes of the client's overall condition, can be essential for the client's quality of life in the future.

Q: When is home care meaningless?

A: Especially if the client does not like it. It is also difficult to provide health care when the client does not have suitable social environment, family or other social network of persons willing to participate in creating his home environment and participate in delivering post-acute care.

Of course, in theory, we could set up even an intensive care unit at the client's home. However, it would be impractical for both staff and the client, and much more costly than intensive care delivered in hospital. The positive impact of natural social environment on the client's health condition would not work.

Q: What is the guarantee that home care will be of high quality?

A: Home care agencies are established by public administration, local governments, inpatient and outpatient medical institutions, private nurses and physicians, charity or humanitarian organizations and many other subjects.

Providers of home care have to be registered with a relevant public administration office. This office is responsible for supervision over accessability and quality of home care.

Majority of home care agencies are organized in the Home Care Association of the Czech Republic (Asociace domácí péče České republiky - further on referred to as ADP ČR), which, in line with the valid legal regulations, obliges its members with a number of rules in the fields of training and ethics, which have a direct impact on the quality of the delivered complex home care. Obviously, not all providers of home care can become members of this professional organization.

Admission is approved by an ethic and professional committee, which takes into consideration all uptodate information about the applying home agency's quality of home care.

National Center of Home Care of the Czech Republic organizes a number of educational events that inform caregivers about the latest scientific findings. Participation in the educational programmes is recorded in the ADP ČR Specialty Index. The caregivers that have acquired a set number of participation points in their educational curriculum can obtain a Certificate of Quality, marked with a registration number, which is valid for 2 years. The validity can be extended only if its holder has, again, acquired the obligatory number of the educational points. This system of continual education of ADP ČR members is called 'cyclic defense of a home care provider's competence' and it is obligatory for all members, physicians as well as nurses, physiotherapists or other caregivers.

Conclusion

To conclude, I would like to wish you sound health. However, if you or any of your relatives or friends suffer from a disease you cannot manage without professional assisstence, you should consider making use of the newly established home care system. I did my best to introduce the way home care works. I believe that this information, together with your GP's motivation and high quality and accessibility of home care will result in significant dicrease of hospitalizations, which might positively effect even you, your family or your friends.

Bc. Blanka Misconiová
president of ADP ČR