If you have been to a modern hospital ICU, you would be familiar with the stench of pain. Hope and prayers hang thick in the air. Most of all, the sight of people waiting outside, eyes piercing through the glass windows waiting for news about their loved ones.
Now imagine an ICU where a family member can sit beside the patient, hold the patient’s hand in prayer and is part of the intensive care environment. This is the comfort that ICU at home brings to patients. “Critical care treatment is difficult for the family of the patients. ICU at home allows them to take care of the loved ones in a controlled environment,” says Dr Gaurav Thukral, senior vice president and business unit director, Healthcare at Home.
A distraught family of Mohali-based Sangeeta Singh found ICU at home to be a blessing. Sangeeta, 25, met with an accident while riding to work and sustained head injury and multiple fractures to her face. During the three months of hospital stay, she acquired hospital infections. “It was very disheartening to watch Sangeeta suffer. Usually, for critical patients, a feeding tube is inserted through the nose. In Sangeeta’s case they had to insert the tube through her throat as her full face had fractures,” says Harmeet Singh, Sangeeta’s father. Sangeeta’s condition and her escalating hospital bills were troubling her father. That was when her doctor suggested she be shifted to an ICU at home. The doctor explained to Sangeeta’s parents that her care would not be compromised by her being at home. “I could see the happiness in her eyes when Sangeeta was shifted home,” says Harmeet. It took six months for her wounds to heal. At present she has not recovered from the neurological damage but she can walk to the dining table and eat with her family. “The clinical outcome for such patients is much better as there is a great amount of a sense of well-being psychologically because the patients are in their own houses with their own family members,” says Sudhaker Jadhav, regional head, Nightingales Home Health Services.
“There is a definite need for this kind of service in India,” says Sudhaker. “In India there are only 70,000 ICU beds whereas over five million patients require ICU care,” he says. “Patients who are bedridden and require long-term care, patients who are difficult to get off the ventilator or are on and off the ventilator, like neuro ICU patients, benefit from ICU at home,” says Gaurav.
Delhi-based Amar Kumar’s family vouches for the benefits of ICU at home. “My husband suffered a massive heart attack at home. By the time he was taken to the hospital, he had already suffered brain damage but the doctors revived his heart,” says Hema, Kumar’s wife. “Doctors gave up hope but I said he will not be dead to me till his heart was beating. However, the hospital expenses were high and I could not afford the treatment.” Home ICU worked out to be relatively cheaper, so Hema brought her husband home.
“For two and a half years now the patient has been in the ICU at home. In this time he has had little clinical improvement but has not had any life-threatening infection or bedsores that are more likely for a patient like this,” says Gaurav. “In a metro city, per day ICU expense would vary between 060,000 to 01 lakh whereas home ICU expenses are in the range of 010,000 to 020,000 a day.”
Different ICU at home service providers offer different packages. “ICU bed, special mattresses, oxygen cylinder, syringe pumps, suction machines, IV stand, etc, are the equipment used in a hospital ICU and can be set up at home,” says Dr Vinay P., an intensivist in Bengaluru. “The cost of the package depends on the requirement of the patient. Packages include equipment, nursing care, hygiene assistant, intensivist visit, physiotherapist visit, nutritionist, etc. Some packages may include regular laboratory test and other diagnostic test also.”
Some people think that setting up an ICU at home requires a lot of space. “In a place like Mumbai even a 1BHK flat is good enough to have a home ICU setup,” says Gaurav. “It’s a myth that you need a big space which should be secluded to run a home ICU. We have set up a home ICU in the hall of a 1BHK flat as you require only space for a bed and a three feet radius around it. The only limitation is that you can’t have pets or children going into that area.”
Documentation and data transmission through digital connection has made ICU at home very efficient. All the care givers working with Healthcare at Home are trained to use tablet devices to input assessment forms as they would do at a hospital. All this data can be electronically transferred to the hospital or an intensivist, who can monitor the patient from a distant location also.
Besides this, most home ICU providers have robust emergency protocols. As soon as the care giver (nurse or doctor) at home senses an incident, they follow the protocol and are equipped with inventory bags like a crash cart in the hospital. Besides this, an ambulance facility and hospital are earmarked so that the patient can be taken there in case of emergency.
ICU at home is definitely a boon for patients as well as the overcrowded hospitals but the flip side is that only a handful of providers offer this service, mostly in and around the metros. Says Vinay, “Although ICU at home is required all over India especially in rural areas, it is very unfortunate that this facility is available only in small pockets around metro cities. The need of the hour is for more providers to bring ICU facilities closer to patients.”
