Naren Katrekar* is happy that he can spend quality time over books and conversations with his 75-year-old mother, who is battling pancreatic cancer. Given her age and worried whether she could survive intense chemotherapy sessions in her fragile condition, the corporate trainer signed up for post-hospitalisation cancer care services at home so that she could recover in a familiar and comfortable space with round-the-clock attention. Most importantly, he could get rid of steep hospital bills.
“Otherwise, I would have to take half a day’s leave to take her to hospital for follow-up therapies. Then we would have to wait there with other patients in queue and since she is immuno-compromised, would have exposed her to the risk of infection. At home, she has no discomfort and I can work remotely too. Besides, I would have to pay the daily hospital room rent besides the services,” he says. The at-home care has saved him a lot of running around for consultation with different specialists. “Now a healthcare professional administers her infusion (the chemotherapy medication that is delivered to your bloodstream through a needle in a vein from your arm). A nutritionist helps her manage post-chemo nausea and customises her food, a physiotherapist helps her move around the house and garden while a doctor visits every week to assess her parameters and ensure she doesn’t slip into an emergency situation,” adds Naren.
WHY IS CANCER HOME CARE PICKING UP?
More and more cancer patients in Pune and other cities are now accessing follow-up care services at home as these save them time that would otherwise be spent shuttling to and from hospitals in their fragile condition. At home, they have a psychological comfort zone. Healthcare professionals at home can also pick up signs and symptoms of criticality and attend to them on the spot, avoiding trips to the emergency room and rehospitalisation. Most importantly, such services come at lower costs and could trim out-of-pocket expenses, involving long-term convalescence.
“Even in the most basic of ICUs, costs could range from Rs 20,000 per day in cities like Pune to even double in other metros and corporate hospitals. However, home healthcare costs not more than 10 per cent of the amount you would have to pay in hospitals,” says Dr Sujata Malik, a former Army Medical Corps doctor herself and now CEO of Sunburst Health Care Private Limited, which provides such services across cities. A few hospitals, too, extend out-patient services.
With a service network spanning Pune, Mumbai, Bengaluru, Chennai, Baramati, she says, “Beyond big cities, such services are also ensuring accessible care for many cancer patients. We have provided services to 10,000 serious patients already and catered to over 2.5 lakh patients who had lesser requirements like changing the catheter, administering IV and organising doctor visits,” she says.
MANAGING PAIN AND NUTRITION IS BETTER
In fact, home services may be better in monitoring the two key pillars of both curative and palliative care for cancer patients — pain management and nutrition. Says Dr Kamlesh Bokil, surgical oncologist at Ruby Hall, Pune, “Pain is one of the major side effects of cancer curative treatments. Worse, it changes as the disease progresses or in between treatments. At-home service providers can monitor the pain regularly, according to the WHO’s pain ladder, and decide on using oral analgesics, morphine or skin patches. They link it with biochemistry tests and report to the specialist who can then adjust the medication.”
Similarly, a patient can waste away if the nausea and loss of appetite hamper their nutrition requirement. “This differs from cancer to cancer. When nutritionists come home, they can work with the patient’s kin to map out a food plan that aligns with what the patient is used to,” says Dr Bokil. It is not enough to suggest the patient must have a diet rich in proteins, vitamins and minerals and low on fibre. A nutritionist will be able to suggest which food works best for which patient. A patient may need more liquids, soups and juices.
“A healthcare professional knows how to give tube feeds via an enteral feeding pump. The relatives have to be taught how to make these tube feeds and use the pump. We prefer formula feeds and mix them based on the patient’s nutritional requirements. We also add salt, probiotics and trace elements to each feed. Weight and other vitals are regularly recorded in an Excel sheet that is mailed to me,” Dr Bokil says.
The nutritionist can help make adjustments on the spot. If the patient’s mouth is sore, they may need to avoid too much acid, such as lemon or other citrus fruits, or spices. Patients can manage smaller meals than three big ones. Also kitchen hygiene is of utmost importance to ensure the patient doesn’t pick up an infection. More plant proteins, freshly cooked food and no packaged and processed foods.
A MULTI-PRONGED PALLIATIVE CARE
For caregivers, who are overwhelmed while managing time and special needs of their loved ones, home services are a godsend, particularly when they involve end-of-life care. Mira* opted for at-home palliative care for her late husband, who passed away due to multiple myeloma at 58. “A male nurse monitored his IV infusion and Ryle’s tube feeds, supervised his hygiene, bathing and grooming. He administered injections every eight hours. A clinical psychologist would come in weekly, chat him up and help him through his depression while a physiotherapist visited daily worked on his mobility. The specialist paid a weekly visit. We never felt alone and helpless. From his days in coma in hospital, my husband could rise from his wheelchair and walk again. His quality of life was much better,” she says.
THE COST OF POST-DISCHARGE CARE
Service costs vary depending on the person’s condition. The needs of cancer patients, for example, depend on the type of cancer and stage of disease. “But at an average cost of Rs 20,000 per week, you get medical equipment, comprehensive 24-hour nursing, IV infusions, physiotherapy, nutritional advice, laboratory investigations and pain management. Customised services will have added costs,” says Dr Malik. According to her estimates, the cost range could be anywhere between Rs 700 per unit service to Rs 1,400 per unit service. The daily expenditure could range from Rs 700 to Rs 3,000 per day depending on the number of individual services required.
Home healthcare services are not uniformly covered by insurance. According to Policy Bazaar, “Some plans include reimbursement, some others provide it as an in-built feature and others offer it as an add-on cover.” But they do offer a ray of hope and a will to live.
(*Names changed on request)
For caregivers, who are overwhelmed while managing time and special needs of their loved ones, home services are a godsend, particularly when they involve end-of-life care. (Photo: Pexels) 
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