Elderly people who are not frail and self-sufficient, how to receive (free) care at home

Aging brings with it a series of health problems, more or less serious, and an increase in disabilities with a possible loss of autonomy. How do you do it, then? guarantee care for a non-self-sufficient or particularly fragile elderly relative who can't move from home? The figure from whom the family can ask for help is the patient's general practitioner.

If the bedridden person, cannot be transported to the clinic by carlives alone in a house with architectural barriers and has difficulty moving around, or easily enters a state of confusion and disorientation out of her environment or due to low immune defenses she cannot be exposed to contact with the outside world, the treating doctor schedules home visits on a weekly, fortnightly or monthly basis, based on need – he explains Luigi Maria Bracchitta, family doctor in Milan —. The home visit can be brought forward for an emergency, such as sudden swelling in the legs, thus avoiding unnecessary visits to the emergency room.

The controls

The family doctor at home has the task of check vital signsthe effectiveness of the therapy, any side effects, evaluate the deprescription of medicines that are no longer necessary, correct lifestyle, dietcheck for loss of muscle tissue, which causes weakness and slow movement, and the conditions of the domestic space, suggesting the elimination of carpets and objects to avoid the risk of falling. We can also do video consultations with the specific specialist Jacopo Demurtas, family doctor in Capalbio. Candidate patients may be suffering from: advanced heart failure, respiratory failure, severe arthropathy of the lower limbs, cerebropathy, brain damage, paraplegia, tetraplegia. Even those who suffer from dyspnea and cannot make any effort due to severe heart failure are visited at home, adds Demurtas.

Nursing

If the person needs assistance from a nurse
to treat surgical wounds, ulcers, bedsores, for blood samples and IV drips, to change the catheter, the general practitioner can request the ASL the activation of the Adi, that is, integrated home care of I, II and III levels of intensity, in relation to the criticality of the patient and the frequency of access, through a specific module. Adi is a health service, free for all, which lasts for the necessary time (a week, a month or years) and which involves the intervention of several operators: in addition to the general practitioner and nurse, also a physiotherapist, pathology specialists (through the doctor's prescription), a team of palliative care and OSS (social and healthcare worker), if the person is no longer able to look after personal hygiene, dress, prepare meals. But social assistance from the OSS depends on the resources of the ASL and can be very limited.

Municipality home care service

If ongoing support is needed, the family can resort to Sad, the Municipality's home care service, which makes the OSS available by the hour (here the citizen contributes to the expense based on the ISEE). All things considered, however, SAD today is unable to satisfy all needs and is absent in the smaller and more disadvantaged municipalities. Furthermore, in just 40% of municipal areas, Istat estimates based on 2020 data, integrated with health care. It means, in these cases, that the ASL collaborates with social services to offer assistance to the patient. Thanks to the new territorial healthcare reform, social and healthcare integration will have to become the rule everywhere. The general practitioner can prescribe to the non-self-sufficient elderly person at the expense of the NHS also diapers and aids (mattresses and anti-decubitus cushion, standard wheelchair, bed with side rails, walker, lift).

Home care to be strengthened

Taking care of 10% of the over 65 population by 2026with the strengthening of home care (Adi): one of the objectives to be achieved with the funds allocated to the health mission of the National Recovery and Resilience Plan (Pnrr). Some Regions, such as Emilia Romagna, Veneto and Tuscany, have already reached this quota. The Budget Law for 2021 also provides that all public and private organizations authorized for the provision of home care are accredited by the Region, going beyond the logic of the contract. The accreditation system should have been activated by August 2022. To date, however, it is only operational in Lombardy and Lazio. Their residents who need home care can choose from a list of approved organizations that meet the requirements. Emilia Romagna and Sicily are proceeding to contract the entities, while in the other Regions the path still being defined explains Giuseppe Milanesepresident of Confcooperative sanit.

Single access points and individualized designs

Another reform foreseen by Pnrr that on the system of interventions in favor of non-self-sufficient elderly people (Law 33, 23/3/2023). To make it operational, implementing decrees will be needed, which are not yet ready. The main points are: the execution, in a single location, at the single access points (Pua)of a multidimensional evaluation aimed at defining the individualized care project (Pai), which will indicate all the health, social and welfare services necessary for the elderly person; the promotion of new forms of supportive cohabitation between the elderly and between generations; the integration of home health care with social care; identification and monitoring of Leps, the essential levels of social benefits to be guaranteed throughout the country; the establishment of a national system for the non-self-sufficient elderly population and of an inter-ministerial committee for policies in favor of the elderly.

Corriere della Sera also on Whatsapp. sufficient click here to subscribe to the channel and always be updated.