Home Care Respiratory Training by asn11969


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  Current Status and Outlook of
Home Care Respiratory Therapists
            In Taiwan

                 Shu-Yi Yang
     Department of Respiratory Care Ward,
      Han Ming District-Teaching Hospital,
           Changhua, Taiwan, R.O.C.
According to the Statistics from National
Health Insurance Bureau:
 9000 Patients Depend on
    Mechanical Ventilators.
   The Usage of ICU is 40 Days per
    Patient (15% of Total ICU Usage)
   The Average Annual Medical Cost
    is NT$800,000 per Patient.
   Annual Hospitalization Cost is
    Approximately NT$7 Trillion (8% of
    Total Hospitalization Bill)
   Annual Medical Cost is
    Approximately NT$7.1Trillion (3%
    of Total Medical Bill)
      Reasons for the Urgent Need of
        Long-Term Care in Taiwan
      1.Occupancy Rate in the
        Hospitals Increases.
                                 2.Medicare Resources Wasted
 7.Long-Term Hospital              and Unevenly Distributed.
   Residency Syndrome.
                                       3.Increasing Progressive
                                         Diseases due to Variety
6.Life Quality of the patients
                                         of environment and Air
  and care givers reduces.
       5.Medical Technology
                                  4.Demographic Changes
  The Positioning of Long-Term Homecare
  in Taiwan Medical Structure
  Medicare and Long-Term Care chart -Sanitary Department in 1998


                                        District Hospital

                                        Local Hospital
                                                                                      Home Care Residence
                                                                                      And Services Services
                    Public          Institute of Basic Health Care                         Other Social Welfare
                    Health Office                                                          with Services
The health care of prevention of        The impatient health care services   The rehabilitation and
public hygiene services                                                      follow-up services

                                        Scheme of health care net second term and third term.
 Scheme of citizen                      Improve the health care of hospital emergency call
                                        advanced case plan to outline.
 health care                            The elder’s long term care three years plan to outline.
        The Top 5 of the
Global Burden of Disease in 2000
 1.   Congestive Heart Disease
 2.   Depression
 3.   Traffic Accident
 4.   Cerebral Vascular Accident
 5.   Chronic Obstructive Pulmonary Disease

      To decrease the burden of
      disease is an urgent task.
              Home Care
 Moving the medical care for
  the patients from hospital to
  home can satisfy patients’
  needs, reduce numbers and
  duration of hospitalization,
  reduce medical cost, utilize medical resources
  more effectively, reduce the burden of the society
  and nation, and increase the life quality
  of the patients and their families.
Definition of Respiratory Home Care

 Part of the home care
   is to provide respiratory
   patients with special
   medical care at home
   after being well-planned
   and trained by professional personnel. It will
  control the illness, reduce financial pressure, and
  improve life quality.

                       To support life
   Promote patient                         To improve the
     and family                          patient’s physical,
   self-sufficiency                          emotional,
     within their                         social wellbeing
      limitation.                        and productivity.

To ensure cost
                      Goals of RHC               To provide
 effectiveness                                respiratory care
of respiratory                                 of high quality
    therapy.                                   under medical

                 Promote life    Reduce incidents
                    quality         of illness
Therapies Provided in Respiratory Home
        Care Program in Taiwan
                       Home Respiratory Care

                             Humidity or
  Oxygen          Suction                    Artificial     Ventilator
  therapy         therapy                   airway care      support

 •Concentrator   •AC/DC                     •Speaking,
                              •Nebulizer                    •Bi-level
 •Cylinder        Suction                   •tracheostomy
 •Liquid O2                   •Ultrasonic                   •PPV
                  Machine                    care
     History of Respiratory Home Care
                 in Taiwan
   1973 National Taiwan Hospital set up Respiratory Therapy Department.
         This initiated the role of the Respiratory Therapist.
   1978 Medical equipment companies started providing homecare suction
         and oxygen equipments.
   1988 Respiratory Home Care Organization was established.
   1990 Respiratory therapy equipment started to be used in home care for
         C-Spinal injury patients.
   1995 Respiratory therapist started to be trained for organized home
         respiratory programs.
   1999 THE Respiratory Care Department of School was formally
   1999 Bureau public health of Taipei municipal governments try to do the
         professional personnel of home care to visit patients at home to
         visit the expense of general view planning of implementation.
   2000 All the people health insurance 「Ventilator dependent patient
         integrated delivery system of settle of prospect of care to try to do
         the planning」, and will to list as the fourth also subsidization of
         The ventilator dependent patient
           Integrated Delivery System
 To delegate one main hospital to be in charge of organizing medical
  care among all levels and combining resources in the community.
 This will avoid unnecessary transfers within different medical care units,
  increasing cost, and mistreated patients.

                                          F.F.S    ICU   1-21 days

            Per-diem NT 9,000 per pt’/ per day    RCC(1)    22- 42 days

            Per-diem NT 6,000 per pt’/ per day    RCC(2)        43-63 days

     Capitation NT 110,000 per pt’/ per Month     RCW(1)            第1-3個月

      Capitation NT 90,000 per pt’/ per Month     RCW(2)                  第4個月起

    Capitation NT 27,000 per pt’/ per Month   Home Care
 Survey of Patients’ Willingness towards
          Method of Treatment

Method              Number of People   Percent
Hospital Stay              10           43.5%
Patient’s Home             12           52.5%
Convalescent Home           0              0%
Unable to Express           1            4.3%
 Survey of Families’ Willingness towards
          Method of Treatment

Method              Number of People   Percent
Hospital Stay              19           82.6%
Patient’s Home              2            8.7%
Convalescent Home           2            8.7%
  Problems of RHC in Taiwan

 Concept of RHC is not well spread.
 RHC groups are not integrated.
 Lack of well-organized agent system.
 Government policy and unfair reimbursement system.
 Economy standard has lowered.

     Keys to the Success in RHC
   Patient’s major illness being stable
   Patient’s lung function being stable
   Patient’s willingness to be treated at home
   Family’s willingness to provide care at home
   Financial ability
   Home environment
   Willingness to learn and cooperate
   Instruction from professional home care group
   Periodical home visit from professional personnel
   Proper equipment and equipment maintenance
   Resources from community and society
   Emergency resources (Back up electricity, Emergency equipments,
    Close to the hospital, Care providing personnel)
       RHC Training in Taiwan

 1995: 72 persons
 1997: 84 persons
 1998: 85 persons
 1999: 73 persons
 2000: 84 persons
 Qualified RHC therapists has currently
 reached 398.
Qualifications of RHC Therapists
            in Taiwan
 Possesses RT qualifications.
 Possesses actual working experience.
 Attends 72 hours of RHC training and full
  knowledge of handling oxygen and
  respiratory machines used in home care.

         Services of RHC in Taiwan (1)

Respiratory system check up.
Evaluation of respiratory therapy machines.

Continual assessment before and after treatment.

Execution of the treatment.

Bedside lung function test and measurement.

Cease of breathing monitoring.

Services of RHC in Taiwan (2)

Reevaluate educational consulting and communication
 provided to the patient and the care providing person.
Provide accurate sterilizing procedure and execution of
 respiratory home care equipments.
Communicate with or seek help from doctors or local
 medical centers when needed.
24 hour consulting.                              CRC
 Frequency of RHC Visits in Taiwan

 Maximum two times for the case of ventilator
 Maximum two times for the case of oxygen
  therapy. No more than three time during the
  period of the treatment.
 At least one hour per visit.
 Every day or every week depends on the
  degree of illness. Costs are covered by the
  patients themselves.                     CRC
Function of the home care respiratory therapist

   Discharge planning-evaluates all facts
    of a patient’s respiratory status,
    reviews equipment requirements and
    initiates therapy according to
    physicians prescription.
   Evaluation and monitors equipment
    use and care, and provides correction
    and reinforcement when therapy
    objectives are not being achieved.
   Assesses general pulmonary status
    and re-educates patients in areas of
   Reviews with patients the pulmonary
    rehabilitation-breathing training and
    exercises taught in the hospital.
   Keep patients’ medical charts.           CRC

Coordinator                Care giver

  Case manager           Consultant

  The Difference between the Hospital
  and the Home Respiratory Therapist
Hospital                        Home
. Fixed environment             . Flexible environment
. Regular working hours         . Flexible working hours
. Three shifts                  . Dedicated personnel
. Provide treatment             . Provide treatment and
. Knowledgeable to certain area . Broad knowledge
. Technical                     . Social
. Passive                       . Active

     How to Play a Successful Role
          of RHC Therapist?
 Keen observation skills.
 Ability and knowledge of integrated physical assessment.
 Knowledge and skill of professional respiratory therapy.
 Perfect communication and coordination skills.
 Accurate knowledge and ability to instruct technical skills.
 Be independent and calm under pressure.

             Efforts to be Made towards by
               RHC Therapists in Taiwan
 Possess qualifications, attend home care planning aggressively.
 Expand professional service area.
 Continuously hold professional training meetings and improve
   Standardization.
   Penetrate communities.
   Reinforce communications and interactions among groups.
   Strengthen civilians respiratory care and related knowledge.

Future and Outlook
       To mandate new law to certify
        respiratory therapist by the
        government, which will
        motivate these professional
        personnel to serve.
       To loosen the requirements of
        government reimbursement,
        which will increase patients’
        willingness to participate in
       To integrate RHC groups.
       To establish RHC therapy to
        serve needed families.

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