**5. Components of Home PAL**

To carry out Home PAL, we need to have a dedicated team, trained in palliative care. The patient's need to be identified beforehand. The local volunteers needs to be recruited. They are the contact persons, who would inform the households regarding the date and time of visit of the Home PAL team. Many a times, a member of the Home PAL team may directly contact a family member of the patient and inform him of their time of visit. So, the house hold should possess a mobile or a telephone for easier contact. The home environment should be a safe and accessible place for the team to store drugs and equipment, as well as to talk to the patients and family members to plan for their treatment. The dedicated space in the house for storing medicines should be a safe one outside the reach of children and the patient. They should also carry a basic set of medicines in their home care kit, including morphine to refill the stores at home. Documentation should be properly done. Home PAL forms should be prepared. It will help in proper documentation and recording of the patient details. It should include the consent form, that needs to be read and explained to the caregivers and their signature needs to be taken. The forms should also record the medicines prescribed to the patients with detailed dosage and schedule. A separate 'morphine register' should be maintained to have a note of the correct number of morphine tablets dispatched to the patients. It should be compliant with the local laws and regulations.

Importantly, in order to implement home PAL; the health care team, the patient and the family must agree that the patient can be adequately managed at home, and the treatment plan should be approved by all the stakeholders.

Now, let us come to each of the components in details.

#### **5.1 The Home PAL team**

A full-time nurse and a part-time doctor are the minimum requirements for a home-care team, although this depends on the regulatory and health system norms in the country. A multidisciplinary team of nurses, doctors, psychologists/counselors, social workers and trained volunteers or community health workers is ideal 6 .

#### **5.2 Requirements**

The requirements are tabulated in **Table 1**, under the headings of basic infrastructure, personnel, home care kit and finance [6].

#### **5.3 Home care kit**

The Home PAL team should carry with them a basic home care kit, which includes some basic medical instruments, medicines for managing acute as well as chronic complains, dressing materials and nutritious supply [13, 14]. They are mentioned in details in **Table 2**.

**35**

*Home Based Palliative Care*

**Table 1.**

*Requirement for Home PAL set up.*

*DOI: http://dx.doi.org/10.5772/intechopen.98648*

Personnel Doctors

Basic Infrastructure Central meeting point

Nurses Volunteers etc.

Equipment Documentation

Transportation/vehicle hire Rental for room/storage facility Communication and printing Medication and equipment costs

Home care kit Medication (including morphine)

Finance Salaries for team members

Medical equipment and supplies Stethoscope

Supporting equipment Alternating air mattress

Tools Dressing materials

Storage facilities (including for controlled drugs)

Method of communication (telephone, mobile, etc)

Sphygmomanometer Thermometer Tongue depressor

Forceps

Aspirator Nebulizer Wheel chairs Walking aids

Cotton Scissors Gauze Gloves Plaster

Transfusion materials IV infusion sets

Injector and needle Aspirator probes Urinary catheters

Bladder Feeding tubes

Cannula and butterfly needle

Transport of team and home care kit

## *Home Based Palliative Care DOI: http://dx.doi.org/10.5772/intechopen.98648*


#### **Table 1.**

*Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care*

succeed in achieving what it aims to do.

**5. Components of Home PAL**

**5.1 The Home PAL team**

**5.2 Requirements**

**5.3 Home care kit**

mentioned in details in **Table 2**.

IEC (Information Education Communication) and BCC (Behavior Change Communication) has a great role to play in the success of the Home PAL program. It calls for involving the public health personals, both government and private, who work with the community of that locality. The media needs to be involved as well, for better propagation of the news and information of the Home PAL. Home PAL calls for a wider support and participation from the whole community including the villagers, students, political leaders and governmental staff, for the program to

To carry out Home PAL, we need to have a dedicated team, trained in palliative care. The patient's need to be identified beforehand. The local volunteers needs to be recruited. They are the contact persons, who would inform the households regarding the date and time of visit of the Home PAL team. Many a times, a member of the Home PAL team may directly contact a family member of the patient and inform him of their time of visit. So, the house hold should possess a mobile or a telephone for easier contact. The home environment should be a safe and accessible place for the team to store drugs and equipment, as well as to talk to the patients and family members to plan for their treatment. The dedicated space in the house for storing medicines should be a safe one outside the reach of children and the patient. They should also carry a basic set of medicines in their home care kit, including morphine to refill the stores at home. Documentation should be properly done. Home PAL forms should be prepared. It will help in proper documentation and recording of the patient details. It should include the consent form, that needs to be read and explained to the caregivers and their signature needs to be taken. The forms should also record the medicines prescribed to the patients with detailed dosage and schedule. A separate 'morphine register' should be maintained to have a note of the correct number of morphine tablets dispatched to

the patients. It should be compliant with the local laws and regulations.

the treatment plan should be approved by all the stakeholders. Now, let us come to each of the components in details.

structure, personnel, home care kit and finance [6].

Importantly, in order to implement home PAL; the health care team, the patient and the family must agree that the patient can be adequately managed at home, and

A full-time nurse and a part-time doctor are the minimum requirements for a home-care team, although this depends on the regulatory and health system norms in the country. A multidisciplinary team of nurses, doctors, psychologists/counselors, social workers and trained volunteers or community health workers is ideal 6

The requirements are tabulated in **Table 1**, under the headings of basic infra-

The Home PAL team should carry with them a basic home care kit, which includes some basic medical instruments, medicines for managing acute as well as chronic complains, dressing materials and nutritious supply [13, 14]. They are

.

**34**

*Requirement for Home PAL set up.*



#### **Table 2.**

*Home care kit.*


Nutritional supplements High protein and calorie food supplements

Iron, vitamin and mineral supplements

**37**

*Home Based Palliative Care*

team is described in **Table 3**.

**5.4 Trainings**

*DOI: http://dx.doi.org/10.5772/intechopen.98648*

**6. Role of telemedicine in Home PAL**

in the regular Home PAL services.

**7. Benefits**

up [19].

caregivers.

in the home of the patient.

The suggested minimum training for various members [6] of the home-care

Telemedicine, which literally means 'healing at a distance', is the practice of consultation, care, diagnosis and interaction between the physician and the patients, who are located remotely via different technologies which involves video conferencing [15]. The world has evidenced the grievousness of covid crisis, where it's either risk taking to visit a hospital or it's difficult to arrange transportation every time due to the occasional curfews and lock downs. In such a scenario, the use of technology in the form of telemedicine is surely appealing to be used for palliation as well in the home set ups. It is evidence based that telemedicine has been used to be a success in different parts of the world, especially in the European countries [16]. Telemedicine while used for palliative care has proven to improve the symptoms, quality of life and care for the patient and also results in better satisfaction to the patient and the caregiver. It also saves the doctor's time. But the most important hurdle of using telemedicine round the globe is the technology related complications. To describe briefly, most of the patients eligible for palliative care are elderly, many of them are not techno friendly. There lacks proper connectivity of internet and electricity in most of the developing nations including India, which is a must for a successful telemedicine set up [17, 18]. Though in urban areas, things could be manageable, but the scenario is just the reverse in rural set up. Moreover, there always remains a difference between the in person care and the tele care provided by the councilor or the Home PAL team, when the patient is in his last days of life. Once these challenges are taken care of, there are prospective avenues to incorporate telemedicine

i.Patients are more comfortable in their own home than in a hospital set

ii.In Home PAL, family members are directly involved in the process of

iii.It provides training and support to family members to help them develop as

iv.The home PAL team is able to facilitate quick referral to additional services.

v.Privacy and confidentiality is maintained when the care is being carried out

vi.It helps to increase community awareness of palliative care. Local resources and support networks can be mobilized and training can be provided by

palliative care. So, patient has an easy access to care.

community health workers to others in the local area [5].

vii.Saves traveling cost and time for the patient and his family.

*\* Note: Minimum requirements for home-care team depend greatly on the format of the health system. There are countries where nurses play a larger role, and others where home care is conducted more by doctors.*

#### **Table 3.**

*Training requirements for the Home PAL team.*
