Decision to Nurse at Home


Your Guide to Home Care
Article contributed by:

Tetsuyu Home Care



Most elderly patients desire to go back to the security and comfort of their own homes.  Yet families may have mixed feelings.  While they want to fulfil the patient’s wishes, they also worry if they can cope.  Depending on the level of care required, Home Care can be beneficial emotionally, socially and even financially for families.
If you are considering Home Care as an option for your aged and frail parents, here’s some information to guide you along.



Who Needs Home Care?


Patients who need transitional or short term (three to six month) care to recuperate from a bad fall, major surgery (e.g. open heart, neuro and orthopaedic surgery) or stroke.



Patients who are

battling a debilitating disease such as Parkinson’s or dementia that requires more substantial and ongoing care; and /or frail,


immobile or bedridden due to sickness or old age and require long term and ongoing care.



Patients who are suffering from terminal diseases and wish to spend the last days of their lives at home instead of the hospital or a hospice.


What is Required in Home Care?
There are three main areas of needs to consider:  Home Readiness, Medical Treatment and Daily Care Giving.

1. Home Readiness
The home environment may require some adjustments to receive the patient back home.  For example a patient who is wheelchair bound may not be able to enter the bathroom easily.  Or grab-bars may need to be installed to help the patient sit down or stand up from the toilet seat.  An occupational therapist can help to make an assessment and guide the family.
In addition, depending on the need of the patient, the family also needs to purchase Home Care Equipment, Accessories and Consumables such as

– Wheelchair

– Commode

– Oxygen Concentrator

– Suction Pump

– Nebuliser

– Hospital Bed

– Mobility Aid such as Walking Frame

– Thickener for Transitional Feeding

– Feeding sets and Milk Feeds

– Diapers

– Bandages and Dressing materials
2. Medical Treatment
A skilled nurse may be needed for dressing wounds, dispensing medications and monitoring vital signs. Patients with a larger budget may even opt to have full time nursing care at home.  Doctors may visit to review patient progress and monitor medication or other treatment.  Following a stroke, a physical or speech therapist might visit the home to help your parent learn to walk or speak again.  Patients who are receiving Palliative care may also need pain management medication and counselling (for emotional pain).
If your loved one returns to full health e.g. transitional care patients who have recovered, home health might be no longer needed.  For those with chronic conditions, such as Parkinson’s disease, dementia or a debilitating stroke, the home care would be on-going for the long-term.  This is because the elder requires ongoing skilled medical care.  In some cases, 24-7 assistance and more complex levels of care are required, and therefore, a registered nurse visiting the home is the best option.
There may also be instances where patients need to be re-admitted to hospital due to some complications. The Home Care medical team should make the assessment for re-admission and provide records to assist hospitals in caring for the patient.
One downside to note about Home Care in Singapore is the lack of co-ordination between the different medical workers, which can compromise the care outcomes for patients and lead to confusion for families.
3. Daily Care Giving
Patients generally need help in activities of daily living e.g. eating, bathing, changing, moving around.
In Singapore, families may employ a domestic helper to assist or provide in the care giving for the patient. With the right training and attitude, the domestic helper can really add value to the patient’s Home Care experience.  The extent of training required depends on the level of care required by the Patient (e.g. how acute the condition) and the domestic helper’s own competency level.
The level of supervision available at home also makes a difference.  Regular Nurse Visits can also augment the supervision especially if more complex procedures such as changing a colostomy bag, suctioning secretions from a tracheostomy tube or monitoring a ventilator are required.  Access to 24X7 nursing helpline also gives the helper and families the assurance that help is at hand.

How Much Would Home Care Cost?
The costs is largely dependent on Patient Condition e.g. how acute the patient condition is and level of care required.  The more acute and complex the needs, the more medical team visits would be required.

Having a competent domestic helper would also certainly help to complement the services of visiting nurses, doctors and therapists.  You should always invest in good caregiver training and monitoring for your helper to ensure that she is confident to carry out her duties.  Some families may consider respite care where a care assistant takes over the duty of the caregiver for a few hours or days to allow for rest or vacation.  You may also need some help in care-ordination e.g. sourcing the right equipment or scheduling of appointments with the different medical workers.
All said, your Budget would also determine the level of care you can afford.  Rule of thumb is to budget from $120 for each visit by a Registered Nurse, $200 for an allied health worker visit and $350 for a doctor’s visit. Depending on the qualifications, nurses can charge between $220 to $450 per 12 hour stay at patient’s home.

What are Some Benefits of Home Care?
The number one benefit of home health care is that it allows patients to receive personal care in the privacy and comfort of their own homes.  For aging and homebound patients, in-home care facilitates them in remaining as functional and independent as possible.  This gives them a higher sense of security and dignity.  Receiving home health care helps to reduce unavoidable readmissions to the hospital, and studies have shown that patients recuperating from illness, injury, or surgical procedures heal more quickly and more successfully when recovering at home instead of a medical facility.
Home Care Benefits for Caregivers & Loved Ones

Home health care provides assistance to family caregivers, allowing them to get back to their lives and enjoy more quality time with their homebound loved ones.  Families that are unable to serve as primary caregivers e.g. children who stay outside Singapore have the benefit of knowing that their loved ones are receiving professional, compassionate, and personalized care in the convenience of their own homes.
The primary benefits of home health care include:


Delivered in the comfort of the patient’s home

Easier for family and friends to visit

Promotes healing and provides more safety from infections

Allows more freedom and independence

More affordable than inpatient care

Tailored to the needs of each individual patient

Reduces re-hospitalizations


Is Home Care Suitable for Everyone?

Depending on the condition of the patient and the level of care available at home, Home Care may not always be practicable.  A patient who requires very intensive medical attention and sophisticated equipment would not function well in a home environment.  On the other hand, a fairly stable patient with very limited mobility but no family nor domestic helper as caregiver at home, will have issues with daily living.  They may fare better in a nursing home or medical facility with the appropriate support.


Article contributed by:

Tetsuyu Home Care

Dated: August 2015


Tetsuyu is co-founded by Dr Shinsuke Muto, a leading Japanese Home Care specialist.  His practice You Home Clinic looks after over 800 home care patients yearly in Tokyo and the Miyagi Prefecture.  Tetsuyu Home Care is designed based on the Japanese home care model but adapted to the needs of Singaporean elderly who wish to be cared for at home.  Our care team of Singapore based medical, nursing and allied health experts provide a seamless one-stop care service that is holistic, integrated and high quality.