When you’re really ill...bring home the ICU

Vadiraj 76, a resident of Mysuru, was on a pilgrimage to Mantralaya when he took ill with multiple symptoms, including back ache, vomiting, temperature, shivering and breathlessness. His right hand was swollen badly and his limbs got so weak that he could barely walk. He and his wife got back to Bengaluru, where their daughter Pallavi and her husband Praveen Kumar took charge and admitted him into People Tree, a multi-specialty hospital.

Already a diabetic patient, Vadiraj was diagnosed with MSSA (methicillin susceptible staphylococcus aureus), a harmful bacterial infection that had affected his vertebrae, lungs and skin, and was immediately admitted to the ICU, where he was intubated and his right hand operated upon. Thereafter, while on the ventilator, he developed pneumonia and bedsores for which he was treated.

After three weeks in the ICU, he was tracheostomised and shifted to the ward. Bedridden and still on the ventilator, he developed Urinary Tract Infection for which he was given antibiotics. On stabilising after three weeks in the ward, the consulting doctor at People Tree, Dr Mohan, advised him to shift home with the high-level, critical care support from Philips ICU@home services.

Mounting bills

Vadiraj was moved to his daughter’s home where one bedroom was deeply sanitised and a home ICU set up by Philips, including a portable ventilator, a suction machine to remove accumulated phlegm and a monitor to keep track of his vitals, with the expert nursing care by two male nurses who worked on day and night shifts. “We opted for the home ICU because of cost considerations and to avoid hospital infections. We paid a whopping ₹14 lakh for 45 days of dad’s hospitalisation, including ICU charges of above ₹20,000 per day,” Pallavi told BusinessLine . Whereas, Philips charged just ₹4,500 per day.

This incident took the family by total surprise as Vadiraj led a disciplined life, keeping his insulin-dependent diabetes under control and never envisaged a situation like this one. What made matters worse was his poor health cover of ₹1.5 lakh, which was hopelessly inadequate to pay his hospital bills. “My father was meticulous with his financial planning, but now, his finances are badly hit. Neither he, my mom nor us ever imagined that he would contract sepsis. I feel really bad that despite my husband and I running our own financial and investment planning company, we did not plan my dad’s health cover at all,” rues Pallavi.

On why she didn’t choose to set up the ICU@home at her dad’s house in Mysuru, she said: “Mysuru is a small town, what if the cardiac monitor breaks down and we don’t get an immediate replacement for it. Here in Bengaluru, we get doorstep services from medicines to surgical perishables like gloves and face masks and immediate replacements of malfunctioning machines.”

Pointing out that ICU@home is a wonderful alternative to a prolonged hospital stay, Pallavi said: “My dad has responded much better at home and is now free of all external attachments to his body. However, he has lost muscle mass and is still bedridden. We have now replaced the critical care nurses with regular nurses who work in two shifts.”

Launched in September 2016, Philips Home Care Services Pvt Ltd, which employs 200 doctors, has served over 2,500 patients in six cities, including Delhi/NCR, Bengaluru, Hyderabad, Mumbai, Pune and Chennai. The company works directly with doctors in more than 200 hospitals.

Dr Preeti Sharma, Clinical Head, Philips Home Care Services India Pvt Ltd, said Vadiraj was informed that he would require tracheostomy up to three months at home, but it was removed in 33 days.

There are good reasons to convert a home into a ‘hospital’ when the treatment is as effective. First, it avoids the hassle and hazards of commute. Second, a hospital visit always carries with it the risk of contracting infections, which can be fatal for the elderly. Third, home hospitalisation could be less expensive than admission to a high-end hospital.

Nuclear family compulsions

An aging population, combined with the break-up of the joint family system, has created a lucrative market opportunity for a number of small and large home healthcare service providers.

In Kerala, the State with the highest percentage of 60-plus population, or an estimated four million ( see graphic ), the demand for home healthcare, assisted care and palliative care services is pronounced. The remittance economy of the State has contributed to the situation.

Kochi-based Signature AgedCare is a palliative-cum-home healthcare project. “We provide professional nursing care for those who are bedridden, frail or have a medical condition that needs regular nursing attention,” says Joseph Alex, Managing Trustee of Signature Foundation. This facility is ideally for those who are working or are abroad, who cannot take care of their parents, he adds.

Alex said the aim was to provide good nursing care in a homely atmosphere to the occupants and ensure a graceful exit to the dying. “Today, how you die is a big question. Everybody needs a peaceful death,” he said.

“We take care of the terminally ill by providing 100 per cent professional nursing care,” said Alex. “We charge a rental of ₹22,600 per month for an inmate excluding medicine costs. Besides, the company also offers a club membership for ₹9,000 for services such as anytime admission, nurse @your home, care @home, lab @home, day care for the aged and short stay for the aged.”

Home alone, and happy

However, with home healthcare services becoming a reality, the elderly are opting to live “independently.” Ninety-year-old Nrityendra Nath Saha Chowdhury and his 87-year-old wife Madhuri Chowdhury decided to live alone in their upmarket flat in the Golf Green area of South Kolkata, much to the discomfiture of their two daughters.

The Chowdhurys have signed up for the Medical Emergency Alert Service (MEAS) provided by city-based start-up Support Elders. Co-founded by Apratim Chattopadhyay, the company’s MD and CEO, Support Elders started commercial operations in May 2015. It now has close to 300 senior citizens, who have signed up for its MEAS services.

Under MEAS, the company provides a smart and lightweight wristband, which connects with its National Alarm Centre (NAC) when the emergency alarm button is activated – either at home or outside.

In case of a medical emergency, the NAC contacts the ambulance service provider for immediate transportation to one of the enlisted hospitals.

“The smart watch is GPS-enabled, which helps us track the exact location of our members in case they are unable to respond or take our calls. We have a 24x7 team that immediately reaches out to help these people,” said Chattopadhyay.

The company, through its programme, ‘Wellbeing’, has a tie up with Woodlands Multispeciality Hospital, under which it offers 360 degree comprehensive support to elders, including at-home customised care by Support Elders and healthcare by the hospital. Under this programme, the company facilitates home visits by doctors, nurses and physiotherapists from the hospital.

The company also facilitates routine visits, typically once a week, to its members. The average charges for a 12-month subscription under MEAS works out to close to ₹41,000, while the same for the Wellbeing package ranges between ₹42,000-62,000.

The company is looking to consolidate its position in Kolkata and spread its roots to other towns, both in West Bengal and outside. “We are still debating whether to set up our own branches or look to tying up with someone with a local presence,” said Chattopadhyay.

Hinterland outreach

The proportion of the elderly is expected to rise sharply. Home health services will, therefore, need to reach out to ordinary folks beyond the cities.

The India Ageing Report 2017, prepared by the UN Population Fund, says that the “ageing population, which was just 7.5 per cent in 2001, has increased to 8.6 per cent in 2011 and will rise to 19 per cent of the total population by the year 2050.” This could amount to around 300 million people. At present, 70 per cent of them stay in rural India ( see graphics ).

Citing a success story, the India Ageing Report observes: “Malappuram is now far ahead in the fields of palliative and elderly care, compared to other districts of Kerala and serves as a model for rest of the country.” It cites the achievements of the Kudumbashree community model as well.

The challenge is to expand the scope of home-based health care services so that more elderly individuals and couples can opt to live like the Chowdhurys, or treat themselves like Vadiraj did.

With inputs from Shobha Roy in Kolkata and V Sajeev Kumar in Kochi

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