Challenges of Home Care in Iran: A Focus on the Functions of the Health System

DEAR EDITOR

Home care, as a new form of healthcare services, is extending all over the world. This care is provided at the patients’ homes with the assistance and interaction between caregivers, patients, and families. Home care services include 24hr care, monitoring patient conditions, training medication uses, pain management, physiotherapy, speech therapy, parenteral nutrition, training patients and their families, and other similar services. In addition to reducing the imposed costs on patients and health systems, home care as an alternative to some hospital services, enhances the patients and their families’ satisfaction, shortens the length of hospital stay, and reduces the problems associated with the presence and hospitalization of patients in hospitals. ¹

Home care is a new phenomenon in the health system in Iran, and the first laws for establishing home care centers were defined about 20 years ago. ² However, no standard executive processes or instructions have been yet defined for home care provision, and these services are not implemented clearly and transparently in the formal structure of the Iranian health system. ³ Home care services are often provided in private and charitable centers and less frequently at medical sciences universities. ² The increase in the number of cancer patients, overload of chronic diseases, growth in the elderly population of the country, changes in economic condition, increase in life expectancy, and variations in lifestyles highlight the necessity of considering home care in the health system in Iran more than ever. ⁴

Depending on the health system specifications and cultural, economic, political and social circumstances, home care takes different forms and faces varied challenges and problems in every country. ⁵ Many Iranian studies have identified and examined the challenges of these services by running surveys among nurses, caregivers, physicians, managers, and policymakers. By adopting a systematic perspective and focusing on the main functions of the health systems, we can categorize the shared challenges in these studies into four main categories including stewardship, financing, resource creation, and service delivery. ⁶

The lack of government commitment; weakness of rules, regulations, and structures; lack of monitoring and accreditation structures and standards; lack of standard implementation processes; deficiency of the national information management system; intersectoral and inter-professional incoordination; treatment centeredness; and priority of hospital services are among the stewardship challenges for home care. Concerning the financing and resource creation categories, home care challenges include the lack of resources and equipment, lack of trained human resources, lack of home care centers, rise in the service prices and costs, caregiver payments, and insurance-associated problems of home care. Concerns about the quality of care; establishment of effective relationships; interactions among caregivers, patients, and their families; security and ethical problems tied to home care providers; distrust in non-physician providers and non-hospital services; and the public’s lack of awareness of home care services are the challenges of the service delivery category.

Obviously, many challenges of home care are related to the stewardship domain. By considering these challenges more meticulously, it seems that solving the infrastructural problems and challenges of this domain can extensively prevent the genesis of challenges tied to other functions due to the strong influence of this domain on others. Of course, as mentioned earlier, home care is still in its infancy in the health system of Iran, and the utilization and acceptance of these services requires culturalization and investment of sufficient time and resources. Besides, training specialized human resources in the home care is another issue that needs to be considered.

Given the necessity of providing home care in Iran, the role of these services in solving some of the most important challenges with which the health system in Iran is faced with, including the lack of human resources, limitation of financial resources, lack of hospital beds, effect of providing home care on the level of satisfaction, and quality of life of patients, the health system managers should take a comprehensive and systemic view to solve the challenges and develop these services in the health system in Iran.

Conflict of Interest:

None declared.

References

1. Masoumi N, Hosseinzadeh M, VanSon C, Ghezeljeh TN. Home healthcare in Iran: A hybrid concept analysis. Iranian Journal of Nursing and Midwifery Research. 2021; 26:196-203.
2. Hashemlu L, Esmaeili R, Bahramnezhad F, Rohani C. The experiences of home care team members regarding the needs of family caregivers of heart failure patients in home health care services in Iran: A qualitative study. Arya Atherosclerosis. 2022; 18:1-10.
3. Alizadeh Z, Rohani C, Rassouli M, et al. Transitional Cancer Care Program from Hospital to Home in the Health Care System of Iran. Asian Pacific Journal of Cancer Prevention. 2021; 22:1231-7.
4. Jafary Gol M, Navidpour H, Sadooghiasl A. Care comprehensive assessment in home health care: qualitative content analysis. Iranian Journal of Nursing Research. 2022; 16:23-32. [In Persian].
5. Nikbakht Nasrabadi A, Shahsavari H, Almasian M, et al. Designing a process model of home care service delivery in Iran: A mixed methods study. International Journal of Community Based Nursing and Midwifery. 2019; 7:288-99.
6. Nikbakht Nasrabadi A, Shabany-Hamedan M. Providing healthcare services at home-a necessity in Iran: a narrative review article. Iran J Public Health. 2016; 45:867-74.