Dr Gaurav Thukral, Sr. VP & Business Unit Director, Health Care at Home India, talks about various challenges of providing healthcare at home, which  also include setting up an ICU.  

It's been five years that you started proving healthcare at people's home. How has the journey been?

We started with a small team. Our job is to convert any bed in a home into a tertiary care hospital bed at one-fourth of the cost.  Our objective was to reach places where tertiary care was not available.

I am happy that we could do it. In fact, we are now present in 33 cities, and are also expanding our services. For example, we administer monoclonal antibodies to cancer patients, and also  provide peritoneal dialysis.
 
What were the main challenges you faced?

The biggest challenge was to get right kind of people and to train them. At- home healthcare is generally mistaken as nursing care. To convince people it was beyond that was difficult.

We need to do a lot of infrastructural changes at home. From footwear, to hand washing soaps, to food, everything changes. We are providing hospital care at home in a step-down form. We take care of a patient's each and every medical need.

The other challenge is that there is no regulatory framework for at- home- healthcare services. I feel just as hospitals are accountable for the quality of service they provide, medical services provided at home should also be under some regulatory framework.

The biggest challenge was to get right kind of people and to train them. At- home- healthcare is generally mistaken as nursing care. To convince people it was beyond that was difficult.

In India there is a shortage of doctors and nurses? Is it not difficult to find doctors for at- home-care?

We have around 500 doctors on our panel who work part time with us. Yes, to get and retain trained nurses is a big challenge. We run training programmes for our nurses in different specialties.

How does an ICU at home work?

We do a clinical assessment . In fact, homes are safer than hospitals for patients who need extended care. In hospitals, maximum contamination occurs from fellow patients but at home, there is only one patient. The environment is friendly and one is immune to whatever little bacteria present.

To make it sterile, one has to clean the floor twice a day with anti-septic floor cleaner. We don't allow pets and kids into that room, and we ask the family not to bring food or flowers into that room.

How has technology helped you?

Tremendously. The first and foremost is the documentation of the case. We keep all electronic record, ours is a paper- free system. It helps in easy monitoring. Artificial intelligence is changing patient care. And then portable equipment such as X-ray, glucometer, ECG help a lot.
 
Healthcare is becoming more and more expensive. Can homecare be an alternative to hospital?

It is extension of hospital care. We need multi-specialty care to stabilise a critically- ill patient. Even at hospital, a patient moves from an ICU to a ward after he stabilises. These patients can be given specialised care at home in a cost-effective manner. 

In tier-2 and tier- 3 cities, our responsibility increases. There, it is difficult to get specialised tertiary care. We get a lot of patients from smaller cities, where people are more receptive of our services.
 
Do you get patients directly or through hospitals? 

At times, hospital approach us and, at other time, patients. In any case, we take a patient under the supervision of his treating doctor.
 
Do you also provide palliative care?

Many people can’t afford this in India. The cost of treatment is so high that by the time a patient requires palliative care, the family has exhausted all its funds. Besides, it is not covered under insurance. 

How do you deal with burnout and psychological stress of your staff?

We have limited work timings which doesn't lead to burnout. But yes, nurses are prone to psychological stress as they care for the sick and elderly. We use technology to address this problem. We have platforms for social interactions. We ensure that our staff meets on a regular basis.