Additionally, the first author has worked with older adults in a nursing-home setting and in community based home health care.
A small group home which will be operational in January 2008 in Berovo will provide care in a community based home environment for five to eight children.
South Coast Hospice (one of our participating facilities) has pioneered the successful integrated community based home care model, and a national network of hospices operates according to accredited standards.
HIV: Human immunodeficiency virus; AIDS: Acquired immunodeficiency disease; ARVs: Anti-retroviral therapy; WHO: World Health Organisation; QECH: Queen Elizabeth Central Hospital (Blantyre, Malawi); SSA: Sub-Saharan Africa; ICHC: Integrated community based home care.
Basic requirements of these models are the provision of care in the patient's home that: (1) reduces or eliminates inpatient hospital stay; (2) is similar to care provided in hospital and clinically appropriate; and (3) is not provided by usual community based home care services.
Programmes such as the integrated community based home care (ICHC) models from South Africa [ 7] provide some ideas as to how such programmes may be implemented, though the dramatic paucity of resources for health care and of human resource in Malawi may limit replication.
33 Rehabilitation in this population included inpatient, outpatient, community based, or home based exercise interventions.
Community based palliative home care has been found to have a positive impact on quality of life and reduce health care expenditures for persons faced with a life limiting illness and their informal support network [ 3, 4].
4 We now review this experience and add data from patients we treated at a community based nursing home, and from a unique experience with a frail population of patients cared for by a dedicated congestive heart failure service.
6 9 Successful models of community based and home based palliative care in the region have been described, but so have considerable challenges, 6 including lack of access to essential drugs, poor social conditions, criminality and urban violence, high morbidity and mortality in health workers, and a lack of trained professionals.
Use of community health and support services in the previous four weeks (home help, home delivered meals, home nursing, community based allied health services, home maintenance, day care centre), hospital admissions in the previous four weeks, and falls in the previous twelve months were also collected via the questionnaire.
