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Home-Based Care

The largest programme run by the Health department is the Home-Based Care (HBC) project. In this programme, trained staff attend to the palliative and health care needs of individuals who have been discharged from local clinics but still require ongoing care within their homes. These individuals’ families in most cases lack the necessary knowledge, skills and resources to provide them with the care that they desperately need in order to manage and treat their illnesses and injuries. Clients who are discharged from clinics are immediately assessed by the Hermanus Rainbow Trust’s dedicated nursing coordinators, who then draw up individual care plans to suit the clients’ specific needs. Clients are then each assigned a care worker who will follow-up on and administer their care plans.

Depending on the nature and severity of the clients’ afflictions, care workers may be required to visit some clients up to three times per day. They perform tasks that include assisting with bathing, cutting hair and nails, exercising limbs, supervising intake of medication, changing bed linen, and doing basic dressings. They also undertake to empower family members by imparting vital health information and teaching them how to care for their dependents. In many cases they will also provide emotional and spiritual support. Should the care workers clients’ physical or mental health become critical beyond the care workers’ capacities to provide adequate care, care workers refer their clients to clinics, hospitals, external social workers, or other departments within the Hermanus Rainbow Trust that could assist. Nursing coordinators also make regular follow-up assessments to ensure that care plans are effective and appropriate.

In addition to caring for clients who have been discharged from local clinics, home carers also conduct household surveys that detect any medical or social issues that may need to be addressed. Carers use three screening methods to detect any health problems within households: TB, women’s health, and child health (ECD Health). If medical problems are identified then clients are referred to local clinics for professional assessment, which may result in referrals back into the HBC programme. If carers detect household psycho-social problems they refer these instances to staff from the Rainbow Trust’s social department, who then follow up on these issues. Home-based carers also provide adherence support for clients taking ARV or TB medication to ensure compliance with medication schedules. Support groups are also provided for HBC clients, in which they receive medication and are seen to by physiotherapists and other relevant specialists. The Home-based Care programme and its related community-based services are summarised in following operational diagram:

The Home Based Care Service began in 1998 as an initiative of the Rainbow Trust. Several years ago the national Department of Health announced their Community/Home-Based Care programme that would be implemented by provincial health departments in partnership with local nonprofit organisations. The state initiative was a perfect fit with the Rainbow Trust’s existing care programme, and the Trust became the Department of Health’s official partner for carrying out home-based care in the Overstrand Municipality. The partnership ensured that the Rainbow Trust would have regular (but limited) state funding for the programme, and services were expanded. Staff from the programme are able to make use of various Department of Health support structures and resources, which assists with the efficient delivery of services and the psychological well-being of the carers.

The Trust’s home-based care service not only improves the lives of individuals in impoverished communities, but also operate as a skills development programme for staff members. The programme operates according to standards set by the Western Cape Department of Health, and service provider staff are therefore required to be trained according to these standards. The province provides free training for carers through multiple skill levels, through its Expanded Public Works Programme. As staff members progress through the levels of training their salaries increase. Once carers have reach their level 4 training there are mechanisms in place for channelling them into full nursing training. A nursing shortage exists in South Africa and there will therefore be sufficient employment for individuals who progress to that point.