The home care team must be able to reach the patient's house within a reasonably short time (perhaps within 30 minutes). This limits the geographic area which can be covered by the team. In many large cities the roads are so congested that it would be impossible for one team to cover all of the city. The accessibility of the patient's house should therefore be considered when accepting a patient for home care.
A patient with terminal illness can be cared for at home until death. Many patients wish to be at home with their family surrounded by their personal possessions. They enjoy being able to see familiar surroundings when they look out of the window. They prefer to eat what the family prepares, bathe when they wish and have the peace and privacy which is only possible at home.
As their condition deteriorates, they send more time in bed, they eat less and they sleep more. Pain and vomiting can be well controlled in most cases. If the patient is unable to swallow medications, rectal suppositories or a syringe driver can be used to administer analgesics, anti-emetic drugs or sedation. If the patient is unable to take fluids and is very dehydrated, a subcutaneous infusion of saline or glucose can be given. This can be managed very safely by the family as there is no risk of air embolus, of phlebitis or fluid overload. Some procedures such as peritoneal aspiration of ascitic fluid can be safely performed by the doctor in the patient's house.
