Community Home-Based Care

Part A: Module A5
Session 2
Part A/Module A5/Session 2

Objectives
1.

Discuss the definition, objectives and types of

home-based care

2.

Discuss the essential elements and principles

that should be included in and guide home-based
care programs

3.

Describe major factors to address when

assessing potential home-based care clients and
families

4.

Discuss issues of home-based care that are

specific to their local situation

Part A/Module A5/Session 2

Definition

The provision of comprehensive services,

including health and social services by formal and
informal caregivers in the home in order to
promote, restore and maintain a persons maximal
level of comfort, function and health, including
care towards a dignified death.

CHBC includes physical, psychosocial, palliative,

and spiritual activities and is a very important
component of the continuum of care, which
extends from the hospital, through different levels
of the health and social welfare facilities to the
home.

Part A/Module A5/Session 2

Goal of CHBC

The goal of CHBC is to provide hope

through good quality and appropriate
care that helps patients and families
maintain their independence and
have the best quality of life.

Part A/Module A5/Session 2

Models of Home-Based Care

There are different types or models of home-based

care, depending on national policy or local community
situations.

In determining which model is best for a given

situation, it is important to take into account such
factors as

cost
stigma
community resources
Sustainability
adequacy of systems available to support CHBC

Part A/Module A5/Session 2

Facility-Based or Outreach

Usually a hospital outreach program, which sends

outreach health care workers or teams out to
periodically visit the homes and families of PLHA

Often focus on addressing the nursing and medical

needs, but have increasingly integrated
psychosocial support

Part A/Module A5/Session 2

Community-Based Model
Community-driven and owned: typically relies on
volunteers who reside in the communities covered by
the program
Volunteers are trained to provide basic nursing care,
emotional and spiritual support to the patient and
family members
Volunteers instruct family members in caring for the
patient and provide back-up support through regular
visits
Transport costs minimal since volunteers live close to
families
Challenge is to maintain and support the volunteers
Part A/Module A5/Session 2

Integrated Model
Combination of facility and community based
models: a community-based program which relies on
local health facility for training, supervision, and
supplies for home-care kits and ensures referrals to
patients back to the facility as and when needed
Evolution into this model is a natural one in response
to needs of communities, families, and patients. This
can result in a continuum of care through synergistic
working relations and referrals. For example, there is
a need to explore linking pharmacies with HBC
services.

Part A/Module A5/Session 2

Community Day Care Model

Patients come to a site for a few hours during the

day and get services such as symptom monitoring,
drugs, recreation, and counseling. This gives
caregivers a respite.

Part A/Module A5/Session 2

Essential Elements of
Home-Based Care

Preventative

Instructive

Therapeutic

ARV adherence support

Rehabilitative

Long-term maintenance

Palliative care & pain relief

Part A/Module A5/Session 2

Examples of Services
that can be included in HBC

Part A/Module A5/Session 2

Provision of Care
Basic physical care
Recognition of symptoms
Treatment and symptom management
Referral and follow-up
Prevention for patient and caregivers, including
provision of supplies such as condoms, household
bleach

Part A/Module A5/Session 2

Provision of Care, continued

Basic nursing care
Positioning and mobility
Bathing
Wound cleansing
Skin care

Oral hygiene
Adequate ventilation
Guidance and support
for adequate nutrition

Part A/Module A5/Session 2

Palliative care

See Part A Module A5, Session 1 on Palliative Care

Part A/Module A5/Session 2

Psychosocial Support and Counseling

Effective psychosocial support and counseling is

known to improve quality of life

Caregivers, including both the family and the CHBC

team, must themselves receive support if they are
to support patients

Burnout is a major risk for families and HBC team

members

Part A/Module A5/Session 2

Care of Affected/Infected Children

Programs should include

advance or succession planning for surviving

children and dependents

HIV/AIDS and other terminal illnesses have a

profound effect on childrens lives. Psychosocial
support is critical and involves an ongoing
process of meeting their physical, emotional,
social and spiritual needs.

Part A/Module A5/Session 2

Care of
Affected/Infected Children, continued
CHBC programs can

promote an enabling environment for

psychosocial support for vulnerable children

foster an expanded response by families,

communities, governments, faith-based and
other organizations for the promotion of
psychosocial support for children.

Part A/Module A5/Session 2

Care of
Affected/Infected Children, continued

Programs should include:

Information and education for patients and

families
Training for family caregivers
Immediate practical support for children and
families in distress
Established linkages and referral
mechanisms for services such as legal
support

Part A/Module A5/Session 2

Patient Assessment in the Home and

Developing a Care Plan

Part A/Module A5/Session 2

Holistic Approach
Use a holistic approach
Begin with a thorough assessment which addresses
Patient and family needs and current capacity for

maintenance of basic hygiene

good nutrition
comfort measures
prevention of infection transmission
symptom management
legal support
taking drugs and medical measures which require physician
input
food and income security
source of psychosocial and spiritual support
Part A/Module A5/Session 2

Set Realistic Goals

With the patient, family members, and

interdisciplinary team, establish a care plan
based on the assessment above

Set realistic goals based on the patients

condition, stage of the disease, care plan,
and resources available

Part A/Module A5/Session 2

CHBC Linkages

CHBC volunteers can participate as DOTs monitors

in programs managing HIV-infected patients with
TB

Volunteers can also participate as monitors for ARV

DOT patients

CHBC programs can provide mechanisms for

support in PMTCT programs including
documentation of inadvertent negative outcomes

CHBC plays a role in ART adherence for MTCT

programs or chronic ART management

Part A/Module A5/Session 2

Basic Principles to Guide

HBC Programs

It is good practice to include all sectors of society,

i.e., communities, public and private institutions,
traditional groups

While CHBC does not aim to shift the burden solely

onto the community there should be active efforts to
empower families/communities to take responsibility
for their health with the community sharing
responsibility for care in that community

People living with HIV/AIDS should be integral to the

planning, design, monitoring and evaluation of
programs

Part A/Module A5/Session 2

Basic Principles, continued

Provider services along a continuum of care that

responds to prevention and care needs for the
infected and affected across different stages of
illness and in a variety of settings

Home-based care workers are ideally a part of a

multidisciplinary team that provides access to the
diverse service needs of patients and families

It is essential that there be care for the

caregivers: family members, community
volunteers, and health care workers

Part A/Module A5/Session 2

Basic Principles, continued

There must be an environment and local capacity

(through awareness-raising and skills-building) to
support shared confidentiality regarding disclosure
of HIV status by patients to their families and
caregivers

HBC should be an entry point to other services such

as legal aid, household aid and facility-based care
for patients and families

Programs must address the unique needs of

orphans and vulnerable children

Part A/Module A5/Session 2