Home care has been gaining importance due to demographic shifts, increased life expectancy, and a growing awareness of the benefits of in-home healthcare. It is evolving to meet the changing healthcare needs of its population with a focus on providing personalized, accessible, and high-quality care in the comfort of patients' homes.

home-based care in Saudi Arabia is driven by the desire to provide high-quality, patient-centered care while optimizing resource utilization and supporting patients in their journey towards recovery and wellness.

In our Qassim region , home health care lunched at 2009 and activated initially in 4 stages to achieve the following  purposes:

 Patient Comfort: Home-based care allows patients to receive medical attention and support in the comfort of their own homes, which can be psychologically comforting and may contribute positively to their overall well-being.

Cost-Effectiveness: Providing care at home can be more cost-effective than institutional care, such as hospitals or nursing homes. It reduces the need for expensive hospital stays and allows resources to be allocated more efficiently.

Reduced Hospitalization: By providing medical care at home, unnecessary hospitalizations can be avoided, freeing up hospital beds for patients who truly need them and reducing the burden on the healthcare system.

 Individualized Care: Home-based care enables healthcare professionals to provide more personalized and individualized care tailored to the specific needs of each patient. This can lead to better health outcomes and higher patient satisfaction.

Family Involvement: Home-based care often involves family members in the caregiving process, fostering a sense of involvement and support within the family unit. This can also help in the long-term management of chronic conditions or disabilities.

Preservation of Dignity and Independence: For many patients, receiving care at home allows them to maintain a sense of dignity and independence by remaining in familiar surroundings.

In the past, the emphasis was more on hospital-based care, where patients would visit hospitals or clinics to receive medical attention. However, with changing demographics, increasing chronic diseases, and a growing elderly population, there has been a recognized need to expand healthcare services beyond traditional hospital settings. This recognition has led to the adoption and expansion of home healthcare services in Qassim.

Home healthcare allows patients to receive medical care, monitoring, and support in the comfort of their own homes. It can be particularly beneficial for patients with chronic illnesses, elderly individuals with mobility issues, or those requiring long-term care.  

This type of healthcare is provided by skillful practitioners for patients at home. The service could also cover nursing care, physical and professional treatment, contact language and social medical services.

The following services are provided:

• Home nursing care 
• Medical care
• Rehabilitation and home physiotherapy  
• Home feeding services
• Home respiratory care    
• Home social services
• Home mental health     
• Virtual home health services
• Medicine management   
•  Other support services.

Centralized Home Healthcare Unit created. 

to ensure continuous communication and coordination between home health care and model of care regarding home health care project and initiative in Qassim health cluster and to establish method for follow up and implementation of new pathway in home health care.

• Conditions for accepting patients in home health care in general:

  · Hospitalized patients with stable condition, but still need health care. 

  · Patients who are not hospitalized and in need of health care with the availability of referral and a clear care plan by the treating physician. 

  · Primary health care patient referral and a clear care plan by the treating physician. 

  · Patients at home with a recent health report with clear care plan.  

  · Elderly who needs health follow up. 

  · Availability of necessary health equipment. 

  · Safe home environment for patient and health team. 

  · Agreement consent from Patient/Patient's guardian home health care.

  Home-based primary care

  • Patient referral form should be completed and written in a clear manner location of patient's house, information about care giver and ways to communicate with them through SEHATY system or Mawrid

  Criteria for referral of patient from primary health care to home health care:

  · Patients who follow up in the Primary Health Care center with stable health condition and immobility.

  · Elderly patients who have problems in Functional capacity

  · Patient needs medical care and stays at home, as it is difficult to reach the health facility.

  · Safe and appropriate home environment to patient and medical team to provide medical service through evaluation of HHC team.

  · Geographical locations of his home is not more than 70 kilometers.

  Home-based postnatal care:

  · Referral request is made by the attending physician within 24 hours of giving birth to the home health care department in the hospital. The attending physician shall complete the referral of the post-natal mother to home health care according to the approved form.

  · The mother’s first visit by the HHC team is within the 1st week after delivery and the 2nd before the end of 6 weeks with a minimum of two visits.

  Home-based Palliative care:

  • When patient refer to HHC arranges the initial visit (social worker, nurse, and physician). Full history and physical/symptom assessment/medication reconciliation will be completed during the Initial visit.

   Criteria for patients to be eligible for enrolment in the home palliative care program, they should meet the following criteria:

  • Diagnosis of an incurable, terminal condition, where disease-modifying therapies are no longer possible.
  •  Prognosis of 6 months or less if the disease follows its natural course based on best clinical knowledge and judgment.

  Home-based Post trauma care:

  Emergency department to home care for Trauma Patient "Rehabilitation Prospective"

  •    After Arrival of patient to the ED, classify patients to Minor, Moderate, Severe, Very severe by (Trauma Injury Severity Assessment Score)
  •  Minor or Moderate who is fit for Discharge- Assessment by ED Physician & Consultation to physical medicine and rehabilitation if needed e.g., severe ankle pain. One visit to physiotherapy.

  - Moderate or severe (i.e., need admission) Create Multidisciplinary team (MDT):

  • Assessment for new or existing cognitive, hearing, visual or communication issues.
  • Consultation to be made for each affected system e.g., Consult for Neurosurgeon for traumatic brain injury.
  • MDT Team decide for the need of home care visit, Rehabilitation.

Conditions for accepting patients in home health care in general:

· Hospitalized patients with stable condition, but still need health care. 

· Patients who are not hospitalized and in need of health care with the availability of referral and a clear care plan by the treating physician. 

· Primary health care patient referral and a clear care plan by the treating physician. 

· Patients at home with a recent health report with clear care plan.  

· Elderly who needs health follow up. 

· Availability of necessary health equipment. 

· Safe home environment for patient and health team. 

· Agreement consent from Patient/Patient's guardian home health care.

Home-based primary care

• Patient referral form should be completed and written in a clear manner location of patient's house, information about care giver and ways to communicate with them through SEHATY system or Mawrid

Criteria for referral of patient from primary health care to home health care:

· Patients who follow up in the Primary Health Care center with stable health condition and immobility.

· Elderly patients who have problems in Functional capacity

· Patient needs medical care and stays at home, as it is difficult to reach the health facility.

· Safe and appropriate home environment to patient and medical team to provide medical service through evaluation of HHC team.

· Geographical locations of his home is not more than 70 kilometers.

Home-based postnatal care:

· Referral request is made by the attending physician within 24 hours of giving birth to the home health care department in the hospital. The attending physician shall complete the referral of the post-natal mother to home health care according to the approved form.

· The mother’s first visit by the HHC team is within the 1st week after delivery and the 2nd before the end of 6 weeks with a minimum of two visits.

Home-based Palliative care:

• When patient refer to HHC arranges the initial visit (social worker, nurse, and physician). Full history and physical/symptom assessment/medication reconciliation will be completed during the Initial visit.

 Criteria for patients to be eligible for enrolment in the home palliative care program, they should meet the following criteria:

• Diagnosis of an incurable, terminal condition, where disease-modifying therapies are no longer possible.
•  Prognosis of 6 months or less if the disease follows its natural course based on best clinical knowledge and judgment.

Home-based Post trauma care:

Emergency department to home care for Trauma Patient "Rehabilitation Prospective"

•    After Arrival of patient to the ED, classify patients to Minor, Moderate, Severe, Very severe by (Trauma Injury Severity Assessment Score)

•  Minor or Moderate who is fit for Discharge- Assessment by ED Physician & Consultation to physical medicine and rehabilitation if needed e.g., severe ankle pain. One visit to physiotherapy.

- Moderate or severe (i.e., need admission) Create Multidisciplinary team (MDT):

• Assessment for new or existing cognitive, hearing, visual or communication issues.
• Consultation to be made for each affected system e.g., Consult for Neurosurgeon for traumatic brain injury.
• MDT Team decide for the need of home care visit, Rehabilitation.

Medication management:

· Follow up and ensure that medicines and nutritional therapy dispenses to patient in a timely manner. 

· During home visits ensures that medications administer safely and accurately by the patient, his caregiver and his family. 

· Educate and train the patient and family or caregiver on how to administer medications, including.

o   how to use the medication at times, how often, the dose, and possible side effects that may occur after using the medication.

o   Reviewing the areas for storing medicines in patient's home to ensure safety considerations with regard to storing medicines in special cupboards and secure drawers, reviewing the expiry date and identifying high-risk and similar medicines by means of special signs or colored tags.

o Securing medicines dispensed through primary health care centers through the Wasfaty service.

Virtual Home Health Care: 

o Provide telehealth consultation. 

o Periodic remote monitoring.

Supportive Services: 

o Home Vaccination Service. 

o Provide laboratory test at home.

o Supply of all necessary material to the Home Health Care patients (health supplies).

o Providing some health devices.

Reference

o CBAHl Accreditation Standards for Home Health Care2022.

o Ministry of health HHC Scope of service 2023.

o Qassim Health Cluster - HHC Scope of service 2021.

·        Vital Signs Monitoring: Regular monitoring of vital signs such as blood pressure, heart rate, respiratory rate, and temperature helps assess the patient's overall health and detect any abnormalities or changes that may require intervention.

·        Blood Glucose Monitoring: For patients with diabetes, monitoring blood glucose levels is essential for managing the condition and preventing complications. Home care providers can assist patients in performing blood glucose tests using glucometers.

·        Medication Management: Ensuring medication adherence and monitoring for any adverse effects or interactions are crucial aspects of home care. Caregivers can assist patients in organizing medications, administering them correctly, and tracking their effects.

·        Wound Care and Assessment: Home care providers assess and manage wounds, including monitoring healing progress, preventing infections, and ensuring proper wound care techniques are followed. This may involve dressing changes, wound cleaning, and evaluation of wound healing.

·        Urinalysis: Simple urine tests can be performed at home to screen for urinary tract infections, kidney problems, or other urinary issues. Home care providers may collect urine samples for analysis and interpretation by healthcare professionals.

·        Basic Laboratory Tests: Some home care agencies may offer limited laboratory testing services at home, such as point-of-care testing for conditions like urinary tract infections or monitoring certain blood parameters.

·        Nutritional Assessment: Home care providers assess dietary intake, weight changes, and nutritional status to identify any nutritional deficiencies or dietary issues that may need to be addressed. They may also provide education and support for dietary management.

·        Fall Risk Assessment: Home care providers evaluate the patient's home environment and assess for fall risks to prevent accidents and injuries. They may recommend modifications to the home environment or provide education on fall prevention strategies.

·        Cognitive Function Assessment: For patients with cognitive impairment or dementia, home care providers assess cognitive function and monitor changes over time. This helps in providing appropriate care and support for patients and their families.

Home-based postnatal care policy and procedure.

Referral of Patients from Primary Health Care to Home Health Care Service.

Referral of PHC patients to Home Care Service.