Physician Services in the Home: Planning for the Integrated Home Care of Acute and Complex Illness #95-1

I. R. McWhinney
March 1995

EXECUTIVE SUMMARY

The Federal/Provincial/Territorial Working Group on Home Care has identified an increasing need for complex care in the home, requiring an "Acute Care Substitution Model" of Home Care. This model, of which Hospital in the Home (HITH) is an example, must have the following features:

  • an integrated multi-professional team, including nurses, physicians, physiotherapists, occupational therapists and social workers;
  • a readily available homemaker service at all hours;
  • ability to respond rapidly to referrals;
  • capacity to respond quickly to crises in patients under care of the organization;
  • availability 24 hours a day, 7 days a week.

The world literature on HITH and similar projects is reviewed. Models of acute home care in Canada are described and the five Ontario HITH projects are assessed. Demographic and economic changes, and developments in home care technology make it likely that all communities will need an HITH or similar organization. The limitations in the current services provided by Ontario Home Care Programs should be removed when the Ontario Government's long term care reforms are implemented, thus making it possible for communities to provide home care for patients with acute an d complex illness. However, one obstacle remains. No organization exists for integrating home care by family physicians with those of the home care program. For acute care in the home it is essential to have medical care available, with intake assessment and continuing care provided as far as possible by the patient's own family doctor. It is also essential to have, at all times, a deputy on call who has access to the patient's record and who will visit the home.

The proposal provides a framework for a HITH or similar organization in London, a city of 315,000. A key element is the appointment of a full-time medical director to provide leadership. Since this would be a pioneering venture, an evaluation and research unit should be built into the HITH from the beginning. To conform with the nomenclature of home care in Canada (see pages 1 and 2) we have used the term Acute Home Care Program (AHCP) in the proposal. Hospital in the home (HITH) is an example of an AHCP.