Home-Based Rehabilitation Program

Introduction

The home-based rehabilitation program takes place in the home surroundings. It provides similar benefits as those offered by hospital-based programs. The rehabilitation specialists established home-based rehabilitation programs to overcome the limitations of hospital-based therapies, such as the hospital’s high cost and limited capacity to accommodate more patients.

What Is a Home-Based Rehabilitation Program?

The home-based rehabilitation program is also known as domiciliary rehabilitation as it is based on the patient’s daily activities at home. This program aims to help patients to improve their abilities, regain independence, reduce the use of medications, reduce the number of hospitalizations, and support the families and caregivers of the patients.

What Are the Elements of a Home-Based Rehabilitation Program?

The most common elements of home-based rehabilitation programs are as follows:

• Assessment, monitoring, and reassessment.

• Health promotion and protection.

• Prevention of diseases.

• Facilitation of self-care, self-help, and mutual aid.

• Personal care such as grooming, bathing, and meals.

• Household assistance such as cleaning and laundry.

• Refer and link to community resources.

• Community-based rehabilitation.

• Provision of basic supplies, assisting devices, equipment such as hearing aids, walking frames, and drugs.

• Alternative therapies and traditional healing.

• Specialized support for patients with mental problems such as dementia and depression.

• Management of pain and other symptoms.

• Counseling and emotional support.

• Facilitation of social interactions.

• Productive activities and recreation.

• Opportunities for physical activities.

• Support for families and caregivers before, during, and after the period of therapy.

• Education and training of caregivers.

• Access to food, water, and sanitation facilities.

• Ensuring continuity of care.

After evaluation, patients receive advice and support to begin rehabilitation therapy. Patients under therapy will have regular reviews, monitoring, and feedback.

Who Needs Home-Based Rehabilitation Therapy?

People with long-term health problems and who need help with daily living activities require a home-based rehabilitation program. This includes the following:

1. Chronically ill patients with diseases such as tuberculosis, cardiovascular (heart) diseases, lung diseases, stroke, and cancer.

2. Patients with developmental disabilities such as disabilities caused by poliomyelitis.

3. People with AIDS or HIV.

4. Victims of traffic accidents.

5. People with mental illness, such as patients suffering from depression and dementia (loss of memory).

6. Substance-dependent individuals.

7. Victims of natural and other disasters.

8. People with sensory limitations.

What Are the Categories of Home-Based Rehabilitation Programs?

The home-based rehabilitation program is categorized into five different fields. They are:

• Home Aids or Modifications - Physical barriers at home can affect the rehabilitation programs. Some changes in the home can improve patients’ security and independence. Mechanical or electronic devices are used to overcome the disability of the patients and to enhance their satisfaction and quality of life. The most commonly used devices are the electrical bed, phone, television, fan, light, and remotes to control electronic devices, which makes the patient feel independent in performing basic house chores.

Health care equipment such as catheters, laxatives, gloves, underpads, lubricants, ventilators, suction machines, inhalation, and exhalation machines to prevent future secondary complications. Occupational therapists choose the best aids according to the patient's needs.

• Home Nursing and Family Help - The family members of the patients play an important role in the rehabilitation program. So educating them improves the outcome of the rehabilitation program. The family members may suffer from increased pressure to take care of the dependent patient during the initial days after discharge. Home nursing services are provided to reduce the pressure on families and caregivers. The home nurses help the patients with daily activities such as bathing and dressing.

• Social Support - Social support is necessary to reduce the psychological trauma and depression of the patients. It facilitates occupational opportunities for patients after the illness, which helps in stress reduction. Non-governmental organizations (NGOs) play an essential role in rehabilitation programs. They provide home aids, rehabilitation camps, and educational programs to help the patients.

• Home-Based Primary Care - The multidisciplinary team visits the patient's home. The team provides primary medical care, nursing services, social services, physiotherapy, and occupational therapy. The services vary according to the conditions of the patients. The nurse helps to maintain the health condition of the patient. Occupational therapists promote the functional capacity of the patients by providing necessary aids and equipment and making constructional changes at patients’ homes. This service reduces the frequent transport of patients, thus reducing complications.

• Innovative Models or Methods - The innovative methods include transitional rehabilitation, telemedicine(video conference with doctors), functional electrical stimulation to improve patients' gait skills, and electromyogram feedback.

What Is the Home-Based Rehabilitation Program for Stroke?

The home-based rehabilitation program for stroke aims to provide physical activity, motion exercises, coordination exercises for the upper and lower limbs at home, proper nutrition, personal and oral hygiene, and ensures adequate medication. Advanced robotic home-based rehabilitation is introduced to help post-stroke patients at risk.

What Is a Home-Based Cardiac Rehabilitation Program?

The home-based cardiac rehabilitation program prevents secondary complications in patients with cardiovascular diseases. The caretakers ensure healthy eating, physical activity, stress management, smoking cessation, and proper medication for the patients.

What Is a Home-Based Rehabilitation Program for Patients With Lung Diseases?

Home-based rehabilitation provides pulmonary rehabilitation in patients with lung diseases. It provides aerobic and strength exercises thrice a week. The duration of the therapy is eight weeks. A qualified exercise specialist teaches exercise at the patient’s homes. Portable ergo cycles are provided for the patients.

What Is a Home-Based Rehabilitation Program for Older People (HERO)?

Most older people develop sarcopenia(loss of muscle mass) after acute illness. Prolonged immobility causes loss of skeletal muscle function, decreasing the capability to perform daily activities. So, home-based rehabilitation is essential for these older people. Smartphone applications are designed to engage the elderly in-home care.

What Are the Limitations of a Home-Based Rehabilitation Program?

The home-based rehabilitation programs have limitations compared to hospital-based programs. The possible limitations are

• Program Intensity - Lack of adequate supervision and proper equipment.

• Patient Support - Lack of support from patients and the multidisciplinary team.

• Disease Severity - Short-duration of programs for patients with critical disease will lack benefits.

Conclusion:

Home-based rehabilitation programs have benefits in improving physical function, the same as hospital-based rehabilitation. Home-based rehabilitation is not superior to hospital-based rehabilitation. More research is needed to know its cost-effectiveness and whether it is suitable for developing and developed countries.