“DASHA-HARA” The 10 perils of Emerging Healthcare paradigm in India & 1 “RAMBAAN”- Home Health care
Dasha Hara is a Sanskrit word which means removal of ten bad qualities within you-Kama (Lust),Krodha (Anger),Moha (Attachment),Lobha (Greed),Mada (Over Pride),Matsara (Jealousy),Swartha (Selfishness),Anyaaya (Injustice),Amanavta (Cruelty),Ahankara (Ego)!!
On the eve of Dassera( DASHA HARA) ,I am strikingly reminded of the ten perils of healthcare paradigm in India which need to be addressed through “RAM BAAN”. What could be that omnipotent arrow which could in one go hit and create an impact on the 10 perils of the Healthcare paradigm in India!!
A quick glance of the healthcare paradigm in india shows up 10 perils which are assuming “RAVANIC “( demonic)proportions. These are
1) Geriatric ailments and the issues of elder care:
With over 100 million population which is in the geriatric age group and expected to be going upto 300 mn by 2050 ,addressing the problems of geriatric care is a huge challenge for India due to derth of geriatric specialists, fading family support due to nuclear family structure and changing materialistic nature of lifestyle for the second generation. Elderly people with memory vision, hearing, balance and gait problems and the degenerative disorders affecting every organ of the body are a vulnerable population. With lack of social security more often than not they are likely to spend 80% of their lifetime savings in addressing their healthcare and security needs. Their discomfort with hospital based care and the cost associated with it is a fact which needs little explanation – we need to find alternatives to hospital based care which is more comforting, more homely , less expensive, offers them security, comfort, convenience and is a destination of their choice not compulsion.
Homecare seems to be the default answer to this first demonic head which is staring at the country. Atul Gawande-in his book ‘Mortal being’ has poignantly elaborated about how geriatric care related problems have assumed a gigantic proportion in USA and also in India. He also explains how hospital and nursing care at home and assisted living may not be the answer to their problems. This is predominantly coming out of the fact that their needs are beyond illness- their financial,emotional, psychological & security needs have to be addressed. Home does heal better!!!
2) Chronic Illness:
Non communicable diseases are prevalent in this country in epidemic proportions. With millions of diabetics/hypertensives this nation is a global hub for NCD’s( Non Communicable diseases).The issue with NCD’s is they are long term, need regular monitoring, have likelihood of relapses, and need a combination of things to address- lifestyle modification, dietary changes, stress reduction, medication compliance. A lot of this can be achieved beyond or before hospitals isnt it?? Why wait till you get hospitalised- Home healthcare can address this through protocol based disease management programs which can ensure less target organ damage and better quality of life in the long term.
3) Shortage of beds/skilled personnel :
With a huge gap in demand and supply and the high costs associated with creating a hospital infrastructure the shortage of beds is an issue which will continue to plague this country for a very long time. Both the public and private sector are grappling with this problem and there seems to be no significant resolution of this issue in the near or intermediate term.If at all we see a redressal it will hopefully be in a very long term. What do people do in the interim – We need alternatives /complementary solution to hospital based care which help in prioritizing the most needy ones to hospitals and the others that can be managed beyond hospitals find an alternative destination or the destination comes to them??
Home based care is the ready made solution- no investment in infrastructure, just capacity building and quality control of the home nursing care delivered will lead to a reduced demands on hospital beds. Effective/optimal utilisation of existing infrastructure can be facilitated through homecare services.
4) Cost of healthcare/hospitalization/health insurance
The rising cost of healthcare, insurance premiums-more so for people with underlying ailments( which is not uncommon in India now) will soon become one of the top public policy issue for this country to debate upon. This monster seems to be only getting headier by the day and recourse to avenues which are easy to access, lesser expensive, complementary to existing healthcare system and provides a win win for all stake holders in the money game is natural.
Home healthcare does fit this bill perfectly- lesser cost for patients, reduce LOS for the hospital, Lesser outgo for the insurance companies..
5) Opportunity costs associated with illness of a family member
Imagine you have a parent who has chronic kidney disease and needs to visit every month to the hospital or you have a member of a family who needs a INR test or ABG test every 15 days to monitor .Each one of these episodes involves the direct cost of the visit or the test but additonally has an opportunity cost of travel, risk of accident or fall during transport( particularly for the elderly care ) day off from work and the impact in the professional performance in lieu of frequent absenteeism from work. This is perhaps a story which resonates with a lot of working professionals who are staying with the family. Could there be a solution to address this econo- emotion-omical problem??
Home care can address a lot of these and in the end turn out to be far more economical than just comapring the direct cost of a hospital visit versus a home visit
6) Stress impact of illness of a family member
This is a story of every other family that I know .young couples in late 30’s early forties- Quadrisected in 4 levels of relationships- personal and professional life, ambitious wife or husband and their interpersonal relationships, young parents and their relationships and challenges of bringing up their children, young parents with elderly parents who are physically, emotionally, financially dependent/partially dependent on them. Every day is a tightrope walk with a lot of give and take involved in every relationship. This delicate balance gets lopsided when I person in the family falls ill especially if this needs hospitalization-All the delicate balance of relationships suddenly becomes vulnerable and suddenly the pressure cooker of stress blows off- it becomes impossible to handle this multidimensional balancing art and there is a sudden impact on interpersonal relationships, social life, financial outgo and not to forget the influx of enquires and visits from well wishers or pretending to be well wishers!!! Trust me I have seen this at very close corners’ Could we take away or reduce this stress by handling the illness element for the family —yes people can still continue with their routine lives, social commitments, work related deadlines because homecare can address their healthcare needs without their direct involvement in it . I have had patient family members call me up and say- because of your home care team we went out for a evening after 3 months!!! Our lives were so tied up till yesterday!!
7) Guilt of an Indian son/ daughter:
Trust me, the pursuit of self and penchant for identity has made Indians the chocolate boys or girls for a lot of booming industries across the globe. They have moved from their ancestral hometowns to different parts of the country or to entirely different countries. Many of them have done financially very well for themselves .Unfortunately, quite a few of them either get up or sleep with a guilt of not being there for their parents when they need them most. They are scared of getting old because somewhere they have a realization that their kids will not be around for them too!! Being brought up in India it is very natural for kids to have this sense of guilt as every other household has a story to share of the sacrifices parents have done for their children to be educated. These children who are now NRI’s or are domestic migrants have money but no time, no availability for the parents when they need them. Is there a way we could reduce this sense of guilt?? Could we understand their compulsions, limitations and still find a way to bridge the gap between parents and children- particularly when they need them- during illness or to prevent illness for their parents??
Compassionate home based healthcare coupled with connected technology can certainly reduce the sense of guilt as the children can be assured that the health of the parents is in safe hands and also they can communicate with the homecare providers through the dedicated portal for family meetings. Parents also do not feel that they are being neglected in the later half of their life by their own children.
8) Recurrent hospitalizations/unwanted hospitalization/prolonged hospitalizations:
Working in the emergency department I often felt that a lot of people could have avoided coming to the hospital if someone was watching them at home as far as their diet, weight, medication compliance is concerned. Also , a lot of illness have exacerbations which need recurrent hospitalization like congestive heart failure, COPD-many a times it is the result of pure lack of monitoring, complacency on the part of the patient or the family or sheer lack of knowledge about ones own illness.Is there a way to improve patient /family partnership into managing long term illness, or well being?
A lot of times people get admitted for trivial illnesses like viral fever, minor asthma exacerbations just because they have insurance to claim or because they have no support at home- Can this be addressed in a better manner?
People stay for a longer time in the hospital thinking that hospital is the safest place to be in after a major illness, or post procedure or surgery. Little do people know that hospital acquired infections are one of the top healthcare problems across the globe and the costs of dealing with them can be enormous and sometimes futile. Also, everyday additional stay is extra cost to patient and the insurance companies- Is there a way to prevent exacerbations, reduce recurrent hospitalization, reduce length of stay during hospitalization reduce risk of hospital acquired infections?? Yes HOME CARE is that avenue which through its partnership program with families can certainly prevent recurrent hospitalizations and prolonged hospitalizations. There is lot of evidence to support this fact particularly for chronic ailments like COPD, Dilated cardiomyopathy, Chronic kidney disorders.
9) Delayed hospitalizations:
I have seen Sepsis cases which are treated at home as viral fevers initially and by the time they actually come they are in septic shock of Multi-organ failure particularly in cases of UTI( Urinary Tract Infections).Similarly Chest pain- where people have sat overnight thinking it is acidity or for that matter neglecting early warning signs of stroke and landing up way beyond the window period for acute stroke care. In all of these situations the outcome significantly turns poor just for the want of early notification and transition to hospital care.
If only there is effective monitoring at home, ability to pick up early warning signs with the help of technology , regular home visits , escalation of investigations and treatment at appropriate time- the outcomes in these cases can be significantly be improved- Home healthcare coupled with remote monitoring technology can effectively provide a solution to this. Coupled with e- consults and video consulting facility the ability to pick up and act on the red flags early has significantly improved. All of this can lead to better outcomes during exacerbations through early interventions.
10) Reactive healthcare:
We are a nation which is genetically reactive in nature whether it is safety, disaster response, or for that matter management of own health, we wait till our BMI goes up , we wait till BP/DM/heart attack hits us to start thinking about health. We wait for first health insurance policy to come in when someone falls ill in the family of a neighbour tells a story of how his company health insurance spared him lakh of rupees during hospitalization of this father.
Can we proactively manage our health ? the current health care ecosystem only offers preventive health checks and off late a thousands of gyms have come up. But we all need someone to motivate and monitor else we lose interest in proactive well being pretty soon. As they say “people never do things which are only expected they are likely to do things which are inspected” – no doubt the fit bits/jawbones have lot of takers!!!
Home care can be an effective monitoring, motivating and educational avenue to proactive healthcare and well being. I see this as a major role for Homecare in India in the next decade. We have a large population of people between the age of 40 -60 who are neither very young nor old-they need to proactively manage their health now to avoid problems in old age. This in long term will do a greater good to the country by keeping its younger generation fit , reducing the burden of chronic ailments and also give keep the nation more productive ,healthy, fit people for a longer span of life.
These 10 perils of Healthcare in India need a quiver of arrows complementing each other – hospital based care, universal health coverage, community education etc but if there is one readymade RAMBAAN which can immediately start attacking them simultaneously is Home Healthcare – Just like every year the 10 headed Ravana faces the defeat through a single shot By Lord Rama, I foresee that every year from now on the 10 perils of healthcare in India will be demolished year on year not just symbolically but literally as Home healthcare is an idea whose time has just begun. As they say- Home care does not just add years to life, it adds life to years!!! Happy DASHA HARA!!!