Providing Safe Palliative Care at Home for the Elderly

South Africa’s elderly population, aged 60 years and above, is expected to increase from 7.7% to 15.4% in the next 35 years according to the WHO.

At present, there are over 4 million seniors and this figure will rise to 10.6 million people in 2050. WHO statistics indicate that 38.4% of elderly South Africans aged 65-74 years have physical limitations including eating, dressing, bathing, dressing or using the bathroom. Approximately 49.2% of those over 75 years and above experience the same problem.

Although there are no available statistics as to how many seniors need palliative or hospice care, it is certain that South Africa needs this type of support for ill people. The country has 17% of the world’s HIV/AIDS patients and it is predicted that cancer will increase to 78% by 2030 (The Lancet). Tuberculosis, diabetes mellitus and cerebrovascular diseases are the leading causes of death in SA. Non-communicable diseases represented 60% of the main causes of natural death. NCDs were the main causes of death among 62.5% of female seniors 65 years and above and 48% for the males (Statistics South Africa 2015 Report).

The country has one of the most extensive and advanced systems of palliative care in the continent yet there are not enough resources and infrastructure to handle the needs of the terminally ill and very sick patients. One of the alternatives to ease pressures on the healthcare system and provide relief for the elderly is palliative care at home. To provide good and safe home care, there are several considerations that must be addressed.

Home Care is Not the Same as Hospital Care

There is a big difference between home care and hospital care. Homes are not made for caring those with chronic or terminal illnesses. They may require modifications to cater to the needs of palliative care in a home setting. For example, patients who have some degree of mobility need to be safeguarded from falls and injuries. Various property alterations ensure the safety of seniors such as installing grab bars, stools and rubber mats in bathrooms or ramps for wheelchair users. Beds should have non-slip or senior mattresses and fitted with rails to avoid patients from falling out.

Reducing the Risk of Infection in Homecare

People with chronic or terminal illnesses have weak immune systems and they are susceptible to secondary infections that may exacerbate their medical conditions. Homes do not operate in the same sterile conditions as hospitals do and therefore, need to be regularly cleaned and sanitized. Patients who have lost bladder and bowel control must be cleaned up always to avoid the spread of germs in the room. Carers who are often family members must be taught basic hand hygiene using soap and water before handling the terminally ill, their food and belongings. The use of gloves & protective personal equipment as well as isolation precaution, disinfection and sterilization will minimize the risk of infection not only in patients but among family members and carers.

Accessing Local Services and Equipment

The primary care team of the patient takes charge of coordinating all services and equipment that may be needed for palliative care at home. If a loved one is diagnosed with a chronic or terminal medical condition, the doctor, nurse or healthcare practitioner refers the patient to hospice or palliative care. The holistic approach to palliative care implies that each team member works closely with the other to provide the services and equipment needed for home-based care. Medical aid funding usually covers the costs of palliative and hospice care but if this is not available, community-based financing exists. What should not be overlooked is regular support for home caregivers who need relief from their duties, psychotherapy, guidance, and counseling to be effective in performing palliative care.

In the long-run palliative care at home is cost-effective for the government and the health sector. More importantly, it provides the much-needed respite for the sick, elderly and dying people who need to be comfortable and enjoy a quality end of life by staying at home with their loved ones.