VHI’s HomeCare scheme offers patients in need of treatment the chance to stay at home

WITH OVERCROWDING and bed shortages a constant in the Irish hospital system, an early transfer home can offer much needed relief for recovering patients.

However, while the community health nurse service offers follow-up care for patients arriving home from hospital, up until now there has been very limited care options for those wishing to avoid a stay in hospital – and the chance of contracting an additional infection – altogether.

Then, in February, the VHI launched VHI HomeCare, a new clinical service which is based on the “hospital in the home” concept.

This enables suitable patients requiring domiciliary clinical care to stay in the comfort and safety of their own homes. There they will receive treatment given by doctors and nurses, including intravenous antibiotic therapy, where previously admission to hospital was the only option.

The HSE in the past contracted a private company to provide a similar hospital in the home type scheme but that service was ended in autumn 2008. Six community intervention teams staffed by experienced nurses in Dublin, Cork, Limerick, Clare and North Tipperary have been established by the HSE in its place which aim to prevent hospital admissions and facilitate early discharges.

The VHI’s HomeCare scheme represents a new service offered by Irish health insurers, as while both Quinn Healthcare and Aviva Health offer home nursing services, they are not “hospital in the home” type schemes.

Instead, their respective schemes cover home visits by nurses, and are aimed at providing follow-up care after in-patient stays in hospitals, rather than replacing the need to stay in hospital. Child home nursing benefits are also available from both insurers.

Under the VHI’s scheme, the medical and nursing visits are carried out by VHI HomeCare’s full-time medical and nursing teams, and the team is headed by Prof Gerry McElvaney, consultant in pulmonary and general internal medicine at Beaumont Hospital, Dublin.

Depending on the illness, the nursing and medical team attends the patient up to four times a day, and all services as provided in hospital are provided at home, including IV therapies, blood testing, placement of cannulae, monitoring, dressings etc.

The service is available to VHI Healthcare members insured under Plans B-E including Plan B Option and Plan B Excess Plans.

While the service is a very welcome development for patients, who can avoid the inconvenience, discomfort and the risk of infection that a stay in hospital presents, it also makes good business sense for the VHI, as it reduces the need for expensive long-term hospital stays.

However, the major downside of the scheme is its limited availability. At present, only patients in the Dublin and greater Dublin area can avail of it, and patients are either referred to the scheme by their GP, or by a consultant attached to several Dublin area-based hospitals, including Beaumont Hospital, St James’s Hospital, St Vincent’s Hospital, Mater Hospital, James Connolly Memorial Hospital, the National Maternity Hospital and Naas General Hospital.

If referred by a consultant, patients must come from either the emergency department, from the in-patient wards or the consultants’ rooms.

Moreover at present, only certain ailments are covered under the scheme, so depending on your condition you might find that you are unable to benefit from it.

Currently patients suffering from pneumonias, lower respiratory tract infections, urinary tract infections, cellulitis, chronic obstructive pulmonary disease, anticoagulation stabilisation therapy, osteomyelitis and endocarditis are eligible to be treated in the home when recommended by their consultant or GP and accepted into the programme by the VHI HomeCare hospital liaison nurse manager.

Another restriction is that the service is not available to children under the age of 16.

Nonetheless, it is hoped that the scheme might have broader eligibility in the future.

According to the VHI, the qualifying illnesses are “under continuous review and many new conditions will be added to the list as the service grows”.

In addition, it says that the referring hospitals listed for benefit are also subject to ongoing review, and it is envisaged that more facilities will be added as the service expands.

IT WAS EXCELLENT, I'D HIGHLY RECOMMEND IT IF YOU CAN AVAIL OF IT

Francesco Macari (44), a proprietor of takeaway restaurant outlets in Co Meath, was referred to the VHI HomeCare scheme by a consultant in Beaumont Hospital.

While attending the diabetic clinic in the hospital he complained of a foot ulcer which had become infected, infecting the bone in the foot also, and he was diagnosed with osteomyelitis.

At first, he was told that he would have to spend between six to eight weeks in hospital to receive intravenous antibiotic treatment, but then he discovered the VHI HomeCare scheme, which enabled him to return home straight away.

“I was glad not to be in hospital because you get infections there,” he says, adding that being based at home also enabled him to keep working and to catch up on his paperwork.

“I’d have been tied down in hospital, I wouldn’t have been able to do anything. I’d have been just waiting for the drip all day,” he says.

Another advantage of the scheme for Macari was that the homecare team was able to work around his other treatments.

As part of his recovery process, Macari had to travel into Dublin twice daily for hyperbaric oxygen treatments, on top of the thrice daily antibiotics administered via drip by the VHI medical team.

By the end of seven weeks, Macari’s foot was healed, and he is very happy with his treatment.

“The best thing about it is you’re infection free, you’re saving a bed and you can get on with your work,” he says. “It was excellent, I’d highly recommend it if you can avail of it,” he added.