A new model of hospice at home services in rural areas

Usługa

People living in rural areas have limited access to palliative care, which is due to several factors. The system providing specialist palliative care at home is inefficient in rural areas as the healthcare accessibility there is 2-2.5 times worse than in cities. Rural areas are also affected by depopulation, which results in seniors living alone with no one around to help during illness and with activities of daily living. Another impediment is the insufficient number of diseases which qualify for palliative care at home funded by the National Health Fund. In only two disease groups (out of seven) are there diseases which make the patients eligible for hospice – cancer (C-00 – D-48) and bedsores (L-98).

The innovation involves the creation of a support group for hospices to make the care more flexible and to increase the number of medical conditions making patients eligible for hospice care. The ‘New model of hospice at home services’ introduces several fundamental modifications to the traditional at-home hospice refunded by the National Health Fund. The first change is the individual approach to each patient: the patient's situation and needs are assessed by a physician who chooses the treatment plan and appropriate specialist visits, thus avoiding redundant visits that are not always necessary for the respective patient. Secondly, the caregivers are crucial to the 'New model of hospice at home' as their primary task is to look after the overall well-being of the patients. This may involve a variety of activities, e.g. helping with shopping, cooking, preventing bedsores, doing exercises recommended by the physiotherapist or helping with personal hygiene. As the trial show, the willingness of caregivers to talk to and accompany patients who cannot rely on family support is also very important. Both physicians and nurses visit patients only if the caregiver or person providing care at home cannot offer a medical service. An important task of the caregivers is also to advise the people providing care at home so that they can carry out as many of the care activities by themselves as possible. At the same time, the caregivers should relieve them of some difficult daily tasks, provide companionship and lend a sympathetic ear to them. The 'New model of hospice at home' also involves increasing the number of medical conditions eligible for palliative care at home. During the innovation trial, the care was provided to i.a. patients suffering from cancer, bedsores, chronic non-healing wounds, post-stroke paresis, quadriplegia, senile dementia or depression. Only some of those were eligible for care refunded by the National Health Fund. Compared to the standard hospice model, the 'New model of hospice at home' reduces the overall cost of care by approximately one third, even though the caregivers' work and travel expenses present an additional budget item. This is so because, as part of the model, the patients, without detriment to their condition, are visited less frequently by other medical personnel, i.e. physician, nurse, psychologist, physiotherapist.

Lonely seniors Sick and terminally ill dependants People providing care at home

Hospices District Social Welfare Centers Parishes

A handbook on how to implement the new hospice model

A support group was set up at the hospice to provide additional care to seriously ill patients. As part of the new model, a position a caregiver to seniors was also created. The caregivers, who are trained in personal hygiene, nursing and first aid, travel to the patients by car. In addition to providing the patient with direct care, the caregivers also help with shopping and cleaning, and cure the patients' loneliness with friendly conversation.

Tak

Caregivers with driving licence, qualified to take care of seniors Physicians Physiotherapists A psychologist

Cars for caregivers Bags for caregivers with: blood pressure monitor, disposable gloves, hand disinfection supplies, other equipment

Podmiot prawny

Paweł Grabowski, Anna Borysiewicz of Fundacja Hospicjum Proroka Eliasza

Michałowo, Gródek, Narew, Narewka oraz Zabłudów w województwie podlaskim

Inkubator pomysłów [2020-23]