The Essential Guide For Providing Medical Care At Home | Godrej Interio

1. THE ESSENTIAL GUIDE FOR PROVIDING MEDICAL CARE AT HOME

2. The times have changed and science has reached heights we could never have imagined, resulting in a global increase in life expectancy. With the support of life-saving drugs, exercise, and easily accessible therapies, people can now lead healthier, longer lives. However, when they do fall ill and need to be hospitalised, people are keen to complete the critical care that hospitals offer, and then move back to their own homes to continue those aspects of their recovery that can be managed from home. The growth of urbanization and nuclear family structures make constant vigilance at hospitals difficult. This along with the desire to be back home from the hospital has resulted in patients and their families choosing home health care over hospitals. This situation prevails not only in older people but also in the youth who find it neither economically feasible nor practically possible to stay in the hospital for the entire duration of their recovery. Hospitals also encourage home care as it affects their pecuniary matters. It is ideal for them to discharge patients for whom observation will suffice, so that they can admit patients who need extensive procedures. The ongoing pandemic has introduced a further nuance to this growing preference for home care. Hospitals were running at full capacity, compelling patients to recuperate at home. These patients found themselves in a position where they needed expert advice but were homebound - a scenario that demonstrates that the home health care model can benefit both patients and hospitals struggling with capacity issues. A growing trend and a by-product of the pandemic, is home health care here to stay? Godrej Interio set out to observe and address some important questions in this regard. What are the challenges that patients, their families and home health care agencies face? What is the kind of infrastructure needed to provide adequate care at home? How will this sector evolve to fulfill the needs of patients and hospitals? Our health care experts gathered an in-depth understanding of the home health care industry. The team surveyed patients who were recommended home care as well as those who were prescribed hospital care. Further, we gathered data on their age, gender, the cause and the problems faced during home care or hospital care. With these insights at hand, we attempted to decode the current and future developments in home health care including professional services, infrastructure requirements, technology advancements, pitfalls & advantages, and other aspects that would offer a comprehensive view of the scenario. 02 The Essential Guide for Providing Medical Care at Home

3. A MAGNIFIED LOOK AT THE GROWTH OF HOME HEALTH CARE IN INDIA Home health care comprises medical services like skilled nursing care, occupational therapy, speech-language therapy and physical therapy which can be provided at a patient’s home. Compared to hospitals, these services are less expensive and more comfortable when availed at home. In India, home health care is relatively new. According to industry sources, it is expected to grow at a CAGR of 19.2% by 2025. Urbanisation, the trend of nuclear families, advanced technology and increased awareness are some of the major reasons why home health care is expected to grow in the near future. Additionally, the lowered mortality rate and an increased life expectancy of the elderly by approximately 68.7 years (2012-2016) from 49.7 years (1975) has also stimulated the expansion of this sector. In the next 30 years, senior citizens are set to comprise 20% of the total population. A 52-year-old patient suffering from Paralysis on the right side of the body, said, “I was prescribed home health care by doctors after 24 days of hospitalisation.” Talking about the pros of home care, he said, “I am finally able to stay with my family members. I feel less stressed around them.” 03 The Essential Guide for Providing Medical Care at Home

4. Smart devices for remote patient monitoring, wearables technology and telehealth will contribute further to the adoption of this means of medical care. Patients with medical conditions like cardiovascular diseases, diabetes, Alzheimer's and dementia etc., can be provided with treatment at home. The lack of sufficient medical facilities is another factor that caused the growth of this trend. According to ICMR, India shares about 20% of the global disease load, with about 6% of hospital resources and 8% of professional medical staff. As home health care aims to reduce the burden of hospitals and nursing homes, private and public health care centres are also encouraging its expansion. Considering the perks and the potential of India's home health care market, leading health care organisations are coming forward to expand their reach in this sector. In India, several leading health care brands have begun offering a range of health care services including post-surgery care, in-patient services, and even chemotherapy and dialysis in the comforts of one’s home. They are also planning to tap into the immense potential of rural India home health care by developing partnerships with the government. Home-bound health care can benefit numerous people suffering from various physical, psychological, and cognitive issues. Here are the segments that have seen an increased demand for these services in recent years: People in the age group of 60 years or older Individuals suffering from chronic physical and mental health diseases and disabilities Patients recovering from major surgeries or critical health conditions People who need palliative care and assistance to be comfortable in the end stages of life 04 The Essential Guide for Providing Medical Care at Home

5. SOME OBVIOUS ADVANTAGES OF HOME HEALTH CARE Break for patient’s family Reduced hospital stay Personal hygiene Medication management Faster recovery Lower cost Mobility Reduced hospital stay Senior citizens suffering an injury or illness that requires constant expert supervision, are often recommended hospital care for a full recovery. Professional home health care services and private nursing allow patients to go home for recovery after a relatively shorter period of hospitalization. Adequate measures and the right care also help prevent re-admissions. Break for patient’s family Taking care of the patient full time can prove to be overwhelming for the family. With the option of home health care, that situation can be avoided. The nurses at home can perform multiple tasks including providing medical assistance at any hour and being a companion in need to the patient. Additionally, medical professionals can rest easy in the knowledge that professional hired help will ensure that patients take adequate rest and medication as prescribed. Medication management One of the most common difficulties patients face is taking their medication on time, especially if they have been prescribed multiple medicines. In-home nursing can ensure that the patient is taking the right medication at the right time. Additionally, following doctor’s instructions will prevent the risk of dangerous drug interactions and overdose. 05 The Essential Guide for Providing Medical Care at Home

6. Mobility Home health care is ideal for patients who need assistance in transferring themselves from a wheelchair to bed and vice versa. The arrangement is also beneficial for patients who need help getting to doctors’ appointments or going to social outings. In addition to helping patients move around, hired nurses never leave their patients unattended, thereby ensuring their safety at all times. Personal hygiene Dependent patients often rely on their caregivers for daily activities like bathing and showering. Not maintaining personal hygiene can result in infections. A nurse can always assist patients to carry out their daily routine at home. Faster recovery Often patients feel intimidated by the hospital environment as they are no longer in a familiar setting. In comparison, they feel secure at home, around their family members. At-home care can therefore result in a positive psychological effect and boost a patients' recovery. Lower cost When compared to hospitals, home health care can prove to be less expensive. For patients recovering from minor surgery or an injury, home health care is a boon. However, certain patients need to be monitored throughout the day with the help of medical equipment. In those cases, hospital care is beneficial. 06 The Essential Guide for Providing Medical Care at Home

7. THE CHALLENGES OF HOME HEALTH CARE IN INDIA The option of home health care comes with countless benefits. But like every new development, this mode of medical assistance also has its set of challenges. Lack of awareness is one of the leading problems hindering this sector's growth, followed by insufficient access to services, shortage of workforce, and dearth of accountability. Challenges faced by patients and families their Challenges faced by care providers/nurses and agencies Here is a closer look at these factors: 1. Challenges faced by patients and their families a. Lack of awareness Due to the unorganised nature of the industry, most families often find themselves lost or misguided when it comes to the home care action plan for patients. Our study revealed that only 18% of patients were guided by hospitals. Though crucial, there is insufficient awareness about this aspect of care. b. Physical activity To recover faster, patients signing up for home health care need to follow a healthy lifestyle through regular exercise and a unique diet plan. Mobility challenges are also faced by patients recovering from surgery or paralysis. For instance, individuals who face mobility challenges need a skilled nurse for movement. The unavailability of a skilled nurse can otherwise result in injuries to the patient. Such patients need assistance to perform daily activities ranging from going to the washroom to sitting and eating meals. In particular, our studies reveal that moving patients that require mobility assistance is one of the most stressful aspects for relatives and attendants. Seemingly routine tasks like sitting up to watch television or washing hands require multiple actions of handling, lifting etc. which is difficult for attendants and pose a serious health risk if not done right. “I am completely dependent on my nurse at home. I need her help every day to carry out my daily activities.” said a 61-year-old patient suffering from paralysis. In such cases, safe transfer from one surface to another is crucial to recovery. Inefficient care may aggravate their issues. c. Lack of infrastructure The lack of proper infrastructure is another factor that can affect the patient’s physical wellbeing at home. Appropriate infrastructure may include elements like the right bed, feeding table, required medical equipment and mobility aids to 07 The Essential Guide for Providing Medical Care at Home

8. ensure the patient's comfort. During our study, we found that only 12.5% of patients use manually adjustable beds. d. Mismanaged nutrition Patients at home tend to have trouble maintaining nutritional health, immunity and body weight. While these problems can be solved through a well-planned diet, they often go unidentified. Vitamin deficiencies, including folate and pyridoxine, are also some of the frequent causes of health disorders experienced by home health care patients. These deficiencies are often the result of an improper diet and unskilled caretaker. A good diet and hygienic surroundings are essential for patients recovering via this medium of professional home care. e. Medical insurance Another challenge experienced by the patients’ families is that there is no provision for home health care in medical insurance policies taken by them. It is not economically feasible for patients to pay for the required infrastructure and services without any financial aid. f. Space constraint For families residing in small apartments, space can be a major challenge for both patients and their family members. Despite the will to opt for home care, managing in a lesser space can discourage patients and their families. 2. Challenges faced by care providers/nurses and agencies While there are challenges that patients and their families face while pursuing home health care, nurses and care providers too have their own set of challenges, including the following: a. Lack of adequate manpower The organised home health care sector is still in the nascent stage. This situation also means that currently, the availability of experienced professionals is low. Agencies find it challenging to hire skilled professionals and assign them the most suitable job. b. Generalised training for nurses There is no prescribed degree or qualification for nurses working in the home health care sector in India. As a result, many nurses receive basic training that does not guide them to manage critical situations that can arise while managing patients at home. c. Fewer job opportunities In India, very few agencies offer specialised nursing personnel for home health care services. This reduces the job opportunities for the nursing staff who would like to work in the sector. Until the awareness of home health care grows faster, the uptake is likely to stay restricted to metro cities, thus limiting the job options for nurses in other cities. 08 The Essential Guide for Providing Medical Care at Home

9. As the market for home health care in India grows, agencies that step into the sector meet the following challenges: d. The dominance of the unorganised sector Unaware of the organised agencies in the sector, patients and their families often turn to the unorganised sector. They approach the nurses or caregivers they meet at hospitals or via references. Such a situation creates a setback for specialised agencies for home health care services. e. Mindful scheduling for nurses Manpower agencies in the sector need to be mindful while creating schedules for the nurses. Some of the patients might need caregivers only on certain days. Each patient comes with a different set of requirements and factors like language preference, age, gender, expertise, and experience should be considered. For instance, a patient suffering from a cognitive condition like dementia is likely to need a nurse with a special skill set. In such a case, agencies should follow a set of rules to assign the job. 09 The Essential Guide for Providing Medical Care at Home

10. INSIGHTS AND PLANNING CAN ADDRESS THE CHALLENGES FACED BY THE HOME HEALTH CARE INDUSTRY The home health care sector in India faces multiple social challenges. The problems faced by nurses, patients and families at home can be countered with pre-planning. Medical assistance at home can also be improved by the effective collaboration between hospitals and home health care agencies. Here are some factors that will lead to the development of the home health care industry in India: Increased awareness While patients prepare for discharge from the hospital, their family should be introduced to the scope and possibilities of home health care. They should be educated about everything ranging from the available services to the best home care agencies. The doctors in charge should advise on the course of action for home care. The patient’s consent is equally important; they should be made aware of the nature of aid available at home. Additionally, family or other caregivers should gather the required information to make the transition from hospital to home smoother for patients. Knowing patients’ needs and schedules will help agencies plan better aid. Post-discharge aid by hospital Families should design a robust plan to meet the patient’s physical and psychological needs as they get discharged from hospital. Additionally, a seamless handover of duties must be made from hospital nurses to the at-home caregivers, keeping family in the loop. “After eight months of hospitalisation, the doctors recommended home care. My nurse from the agency helps me move around the house and continue daily routine tasks. I think this setup is more convenient for me as I am recovering faster and she is always around to help”, said a 28-year-old patient who suffered injuries due to an accident. Hassle-free scheduling Post designing the home health care model for patients, agencies should carefully assign the most suited caregiver. Health care staffing agencies should also keep in mind factors like their qualification and experience while assigning the job to a nurse. Infrastructural development The patient’s family should make a list of the medical equipment that the professionals may need to offer extensive care at home. IV units, pain relief pumps, special beds, and professional displacement equipment are often critical for medical assistance at home. “I feel comfortable at home as my bed has everything that I need. We installed a suction machine, oxygen, pulse oximeter, and a feeding table at home”, said the caretaker of a 21-year-old patient suffering from a head injury. 10 The Essential Guide for Providing Medical Care at Home

11. For patients in need of special beds available in the market, Godrej Interio’s Home care Solution provides electronically adjustable beds with backrest and leg rest, which can make a significant difference. We have taken these needs into consideration and created an electronically adjustable bed with backrest and leg rest. The side rails of this bed are adjustable and can be locked at three heights providing maximum safety to the user. The bed can be complemented with a bedside cabinet, feeding table, etc to suit the patient’s need and ensure optimum comfort. Access to the appropriate infrastructure will improve the patient’s and caregiver’s comfort in home care. It will also ensure better pain control, relief, and enhanced mobility for the patients. Additionally, the family members can get in touch with the agency, who in turn can contact the hospital to help plan the ideal infrastructure at home. 11 The Essential Guide for Providing Medical Care at Home

12. CONCLUSION The home health care sector in India is highly unorganised, compared to other developed countries, but the market is in a growing phase, buoyed by heightened consciousness about hygiene, advancements in technology and people’s desire to be in familiar and comfortable environments when they are at their most vulnerable. Considering the growing expertise in the field, adoption will pace up gradually. Progress on the availability of qualified caregivers, suitable infrastructure, medical equipment designed for home care and education for families of patients, will go a long way in contributing to the growth of home health care. Today, multiple health care agencies are emerging in the industry to assist the patients in need. In parallel, numerous insurance companies are expanding their existing models and introducing a provision for home health care to cover the costs incurred by patients and their families. Hospitals are also coming forward and promoting the new medium of medical care by collaborating with agencies that offer at-home medical services, because it frees up their bandwidth to accommodate new patients in need of hospitalisation. With increased awareness, better access to resources and infrastructural development, the organised home health care sector is expected to gain popularity soon. Providing patients with the medical assistance they need, home health care will bring about a positive change. 12 The Essential Guide for Providing Medical Care at Home

13. ABOUT GODREJ INTERIO Godrej Interio (GI) is India’s premium furniture brand in both home and institutional segments with a strong commitment to sustainability and centers of excellence in design, manufacturing and retail. Led by the largest in-house design team in the country in the furniture category and awarded with 34 India Design Mark Awards till date, GI aims to transform spaces with its thoughtfully designed furniture to create brighter homes and offices with products that have the highest design quotient in aesthetics, functionality and technology. With consistent pursuit of excellence and a special focus on health and ergonomics, GI’s product portfolio comprises a massive range. Today, we design and manufacture furniture for office spaces, homes, educational institutes, healthcare facilities, laboratories and more. Along with furniture we offer Audio Visual and 360 Degree Turnkey solutions. Each of our product range revolves around comfort and aesthetics while delivering well-designed, fun and functional furniture solutions. Briefly, Godrej Interio transforms dream spaces to life! GI commitment to the environment has resulted in manufacturing products with lesser environment footprint. Our pioneering efforts include designing less environment burdening products, usage of eco-friendly materials and setting up less polluting and consuming processes, ensuring eco-friendly packaging and transportation and finally the extended responsibility of recycling/reuse of used furniture and scrap, thus ensuring a lifecycle approach to green. Currently present in over 650 cities with 250 exclusive showrooms and 800 dealers, GI is one of the largest divisions of Godrej and Boyce Mfg. Co. Ltd., part of the Godrej Group, one of India's largest engineering and customer product groups. DISCLAIMER This paper represents the opinions of the authors and is the product of professional research. This report has been prepared for the exclusive use and benefit of the addressee(s) and solely for the purpose for which it is provided. Unless we provide express prior written consent, no part of this report should be reproduced or distributed. While every attempt is made to ensure that the information contained in this document is true to its best. However, Godrej and Boyce Mfg. Co. Ltd., its employees, representatives, affiliates or any of its divisions, etc. shall not be responsible for any reliance made on this paper or for any errors / omissions in information obtained from the source while preparing this paper. 13 The Essential Guide for Providing Medical Care at Home