Home-bound elderly care lays thrust on home-based comprehensive assessment

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Home-based comprehensive assessment, standardised repository of protocols for screening and management of geriatric conditions, and home safety audits are some of the proposals in the ‘Care of Homebound Elderly’ component of the Comprehensive Elderly Care Action Plan’ of the State’s Health department.

The proposals have been drawn up keeping in mind that the home-bound elderly occupy the critical middle ground between active, independent older persons and the bed-bound. Since it is a transitional stage, the window when a person is home-bound is seen as the last real opportunity to intervene and preserve functional ability before a person becomes bed-bound.

The action plan notes that being home-bound carries its own compounding risks: fear of falling, anxiety, and depression are common, and these can accelerate cognitive impairment. Home-bound elderly are also disproportionately vulnerable to neglect and abuse and often invisible to the health system. The ‘Care of Homebound Elderly’ component proposes a structured continuum of care beginning with early identification and simplified home-based assessment, followed by periodic professional review, risk-specific interventions, caregiver education, and community support.

It prioritises a simplified assessment tool that can be administered by laypersons (family members, spouses, children), or frontline workers (such as ASHAs, Kudumbashree members and anganwadi workers). The tool, modelled on the WHO ICOPE (Integrated Care for Older People) approach, becomes the person’s baseline health data and can be repeated periodically for review. It covers, at a basic level, fall risk, frailty, nutrition, oral health, hearing, vision, depression and dementia screening.

Mental health screening is built into the baseline assessment tool and reinforced through caregiver education so that early signs of delirium, depression, dementia and mild cognitive impairment are more likely to be noticed and flagged. Screening results can help generate a simple care plan for the caregiver that notes what can be done immediately and what requires referral to a higher level.

Periodic home visits will build on the baseline assessment, allowing each cadre (caregiver, nurse or doctor) to evaluate further as per their skill level. The component calls for publishing a standardised repository of protocols for screening and management of geriatric conditions to ensure that every cadre works from the same reference.

Tele-consultation has also been mooted to extend the reach of these visits. It proposes a home safety audit to be conducted by any trained frontline worker during a routine visit. Alongside the audit, a person’s support system should also be mapped: neighbourhood contacts, nearby facilities they can access, and specifically the nearest neighbour willing to help in an emergency.

A cadre of physical assistants trained in physical activity promotion under the supervision of a doctor or physiotherapist and caregiver education in dementia, balance retraining, baseline assessment, and legal and rights-related instruments such as wills are proposed in this component. Special attention for the marginalised such as the differently abled, transgender persons, and the aged in tribal areas is also proposed.

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