Home is where most people want to be when they are unwell, in familiar surroundings, with their near and dear ones close by. This is true for people with cancer, and especially so when their disease is no longer curable and the end of life approaches. There are other compelling reasons as well.

The majority of families have exhausted practically all their resources – physical, emotional and financial – by the time they are told nothing more can be done for them in terms of curative treatments. By now, patients also are too sick to travel back and forth to medical institutions that have little to offer them besides repeated investigations, which are both costly and unnecessary. Therefore, for practical reasons, too, it is the wish of patients that they be cared for at home; that this care be affordable and appropriate; and that it be offered with sensitivity and understanding to them and their families.

CanSupport's home care teams have made this wish come true for the patients and families they visit and care for in their homes. Each team covers a radius of 25 kms from the field centre where they are based. This often means traveling almost 100 kms through busy and crowded thoroughfares. On an average, they are able to visit six homes in a day, spending about an hour and a half with each patient. During this time, all problematic physical symptoms as well as emotional needs are attended to, and the general situation discussed with the family care-givers. The effort is to adequately prepare both the patient and the family for what lies ahead and to draw up a plan of care that responds to the most pressing needs, which may change during the course of a long and debilitating illness.


 

The Home Care Team:

Ideally a Home Care Team should consist of:

1. Doctor(s) and nurses (the essential core clinical team).
Physiotherapists, occupational therapists and other specific therapists may be used as needed.

2. Social workers, chaplain/priest/rabbi or other spiritual advisors.

3. Volunteers.

The components of a home care team are dependent on financial constraints and availability of qualified personnel. In our circumstances, where there is a paucity of funds and trained personnel, a doctor (usually a general physician) and a nurse, with basic training in palliative care, form the core team.

In the case of CanSupport, we have, from the very beginning, stressed the need to have a counsellor on the team. Consequently, each team is made up of a doctor, a nurse and a counselor. Together, they are able to respond to the physical, psychosocial and spiritual needs of people with cancer or any other life limiting illness under their care.

CanSupport doctors are well versed in pain management and are able to prescribe opioids to manage severe pain as CanSupport has a license to stock and supply oral morphine; the drug of choice worldwide for unremitting pain. Necessary information, advice and medicines are given for other distressing physical symptoms as well. The nurses on the team teach nursing skills to the family care-givers as well as discuss issues related to all aspects of care: including diet, mouth care and prevention of pressure-sores. The counsellor identifies and addresses any psychosocial issues or spiritual needs that the patient or members of the family may have. The support extends to grief and bereavement support for the family.

To summarize, the CanSupport home care team offers:

• medical and nursing care to relieve pain and other distressing symptoms that can accompany cancer;
• an opportunity for the patient and the family to talk over issues that may be troubling them with experienced and caring professionals;
• practical advice and support to family members in their role as carers;
• medical equipment, supplies and nutritional supplements to those with special needs;
• comfort and care that extends to all aspects of the individuals well being, including the spiritual;
• bereavement counselling to grieving relatives.

This patient and family centred interdisciplinary approach to care is known as palliative or hospice care. It enables the family to ask questions and have discussions that will allow them to make informed decisions as the disease progresses and the challenge of the end of life draws near.