Interim guidelines for home-based isolation & care of confirmed COVID-19 cases

Homebased care for suspected or confirmed COVID -19 patients is the holistic and integrated care provided for asymptomatic and symptomatic confirmed cases of COVID-19 in the comfort of their homes. It encompasses biomedical, physical, psychosocial, palliative, and other aspects of care provided by patients, family members, community volunteers and /or healthcare workers under the supervision of a treatment centre with appropriate facilities for evaluation when necessary. As majority of patients are asymptomatic or mild and require minimal interventions for care, the home is an ideal place to manage such patients in a cost-effective manner with satisfactory outcomes. This allows the focus of institutional care to the management of moderate to severe cases. Patients who meet the criteria for home- based isolation and care after assessment of clinical risk, home risk, Infection Prevention and Control, adherence to guidelines, waste management and other factor are enrolled into a specific home- based care team attached to an isolation/treatment centre for supportive care. They are followed up to discharge after a minimum of 10 days after exposure, confirmation of test positivity, or onset of symptoms. The frequency of follow up is mainly based on the clinical risk assessment. Patients whose clinical risk or condition deteriorate are evacuated preferably to their supervising treatment centre. Specific roles of all stakeholders and personnel are clearly delineated with protocols and procedures for data management also well spelt out. Ultimately, it is envisaged that this revision of the home -based care guideline for management of asymptomatic and mild suspected or confirmed cases of COVID-19 would ensure efficient and effective management of covid-19 patients in their home with improved outcomes.

Figuring it out by yourself: Perceptions of home-based care of stroke survivors, family caregivers and community health workers in a low-resourced setting, South Africa

Background: In less resourced settings, formal rehabilitation services for stroke survivors were often absent. Stroke survivors were referred to community health workers (CHWs) who were untrained in rehabilitation. Aim: To describe the experience and perceived needs of stroke survivors, their caregivers and CHWs in a context with limited access to and support from formal rehabilitation services. Setting: The Breede Valley subdistrict, Western Cape, South Africa, a rural, less resourced setting. Methods: A descriptive exploratory qualitative study. Four focus group interviews were held with purposively selected stroke survivors and caregivers and four with CHWs. A thematic approach and the framework method were used to analyse the transcripts. Findings: A total of 41 CHWs, 21 caregivers and 26 stroke survivors participated. Four main themes and 11 sub-themes were identified. Because of the lack of knowledge, training and rehabilitation services, the main theme for all groups was having to 'figure things out' independently, with incontinence management being particularly challenging. Secondly was the need for emotional support for stroke survivors and caregivers. Thirdly, contextual factors such as architectural barriers and lack of assistive products negatively impacted care and function. Lastly, the organisation of health and rehabilitation services negatively impacted home-based services and professional support. Conclusions: With appropriate training, the CHWs can be pivotal in the training and support of family caregivers and stroke survivors. Care pathways and the role and scope of both CHWs and therapists in home-based stroke rehabilitation should be defined and restructured, including the links with formal services