The need for home based care services in India is very strong: Lalit Pai

Even though the intensity of number of people affected by chronic diseases like heart disease, stroke, cancer, type 2 diabetes, obesity, arthritis among others is ever increasing with changing lifestyle, the need for home based care services in India is rapidly growing. Especially the middle and old age patents are in dire need of such home health care services across metros and small towns. Estimated as $3-4 bn, it is one of the most unorganized industries in the country with huge future potential amid growing mass population. Thus, Bangalore based Nightingales has been offering expert home healthcare services in India from last 20 years with currently having around 1000 professionals on board including doctors, dentist, nurse, therapists and bedside care givers. Thus, talking about the services offered and the current state of the home healthcare services industry, Lalit Pai, CEO,Nightingales spoke to Wellnessindia.com.

Please tell us about the kind of home based healthcare services that you offer?

In the last 20 years, we have developed a strong focus on specialty home healthcare services in chronic diseases including pulmonology, cardiology, neurology, oncology, orthopedics, geriatrics and post-operative rehabilitation. We also have preventive care solutions like comprehensive check-up at regular intervals at home for patients staying alone or at risk of specific disease, and vaccinations at home.

We have close to 1000 professionals, across all our branches which include doctors, dentist, nurse, therapists (physio, speech, occupational) and bedside care givers. All of them have the requisite educational qualifications, training and experience to face the unique challenges associated with delivering healthcare at home.

Under what circumstances people opt for home based care services?

Typically, people opt for such services if they or anyone from their family have any chronic diseases. Some also prefer short term post hospitalization, although chronic disease care is mostly for senior citizens. We also have middle aged patients; some prefer regular tests for diabetes and other chronic conditions at home. We have conducted campaigns where we have visited sensitive areas and provided vaccines to those who are prone to such illness. Some of them were for dengue, swine flu and recently Hepatitis.

How do you customize your care solutions according to the needs of the patients?

We have a set of process guidelines; and our first point of call is to conduct an assessment. Based on the assessment, a care plan for the patient is developed and discussed with the treating clinician. The final plan is endorsed by the physician who advises changes as required over a period of time after reviewing progress constantly. The routine plan of the patient is based on the individual needs and medical situation. For a comprehensive care plan there is the need for co-ordination of the people, process and devices. Based on the medical situation, ventilator or other equipment are also provided at home for medical care.

So far how many branches and physical therapy clinics you have and what is your expansion plans?

We are spread across 4 cities, 3 regions and 15 branches. We have few physical therapy clinics in Hyderabad and Bangalore. Here we provide therapies like speech therapy, physiotherapy, certain equipment which help in these therapies, but cannot be taken to individual homes are made available at these PTCs. For better connectivity we shall open more branches in Bangalore, Mumbai, Pune and Hyderabad. Expanding such facilities to Mumbai is on the anvil. This will help optimize the travel time to make operations easy and commitment of time to patients. We also plan to expand in Chennai and Delhi NCR in the next 6 to 9 months.

We employ everyone, but not on contract basis. With the demands growing, we have to constantly hire as recruitment and providing training are some challenges that we face. We are growing by 10 percent on a monthly basis.

Have you tied-up with any hospitals to offer home based care services?
We have collaborated with hospitals and individuals doctors to provide what we call continuum-of-care: where we follow the same care and routine as suggested by the doctors, but within the convenience of one’s home. We follow the protocol similar to the ones in the hospital and if need be rent out equipment like a ventilator as well. All of the clinical metrics are routinely conveyed to the treating clinicians and they can take action based on the clinical progress of patients at home.

What is the state of home based health care services industry in India?
Home healthcare services in India are largely unorganized with most agencies working with untrained and or contract labor. These agencies also change staff regularly which makes it difficult for patients. There is no documentation of what services are being provided at home and the patient’s medical situation.

It is important for the industry to become more organized and more structured in terms of quality processes. This will help make the service delivery more consistent and the quality of the industry will increase as a whole. Once this happens, more insurance players will adopt home care solutions as part of the clinical system of care and make it part of the reimbursement plans and home healthcare will become mainstream.

In terms of market size how big is the home healthcare services market in India and how do you see the space is evolving in the future?
In India, the home healthcare service is still unorganised, rest of the world home health services constitute for 10 percent of the hospital sector. Some statistics show India to have a $60billion market for hospital services, which means home health services may constitute a $5-6billion market but because it is unorganized, estimates place it at around $3-4billion. As this sector becomes more organized and structured, the availability of insurance will also increase and this will drive up the demand.

The need for home based care services in India is very strong. Although hospitalization offers support at the acute phase of a disease, the aftercare taken at home is also very important. Not everyone can afford to continue in the hospital or move to smaller nursing homes. Hence, such home care services for chronic diseases are the need of the hour. Currently, insurance for such services are also not available, but over a period of time there will be more organization in this industry.