Provision of Podiatric services in the home, nursing home & residential Care
Due to mobility problems, Podiatric services are sometimes needed to be provided in the home of the older person. In the context of comprehensive health care this provides the opportunity for assessing patient in home and their abilities to cope. The Podiatrist can be involved in part of general assessment of ability to manage in their own home solicit aid from various agencies and other health professionals (eg unable to prepare food; inadequate heating).
However, podiatric treatment of older persons in their home involves compromises that increase risk to patent and Podiatrist and raises the issue of adequate reimbursement due to the travelling and set up time involved. For these reasons, home visits should be restricted to the strictly housebound. Home visits limits the treatment options available and has the potential to perpetuate social isolation. There is likely to be a psychological stimulus associated with travelling outside the home for the older person. A number of occupational health and safety issues for Podiatrist associated with home visits:
• the need for a safe position for Podiatrists to carry out foot care (eg increased risk of back and shoulder problems)
• cleanliness of patient
• infection control risks (eg instrument sterilisation; disposal of contaminated materials)
• cleaning of hands.
Infection control for home visits is a major issue. The application of infection control principles/policies in the home is a challenge and requires compromises that put patient and health professional at risk. At no time should the patient be compromised and put at risk. Handwashing and aseptic technique are a major part of infection control, but standards are needed as all providers of health care in the home have a professional and ethical responsibility to reduce the incidence of home acquired infection. Many of the infection control standards applicable in a clinic or hospital cannot be incorporated into home care greater risk.
The provision of podiatric services in nursing homes, long term care facilities or acute care in-patient facilities is less taxing than home visits. Facilities for better infection control should be available, but there can be a number of occupational health and safety considerations for the delivery of podiatric care (eg treating patient in bed has potential for risk of injury to Podiatrist).
Role of podiatry in nursing homes/long term care facilities:
education of staff (in-service education)
podiatric evaluation care/treatment plan treatment (use of sterilised instruments; pharmacological agents and wound dressings; physical therapies; prescription foot orthoses)
prevention (eg screening of all admissions identify those at risk comprehensive care plan)
footwear evaluation and advice
Issues involved in the provision of podiatric services in long term care facilities:
• who initiates referral? – patient, family, nursing staff, medical staff?
• type/level of service – toenail cutting, palliative (eg nails, hyperkeratosis), acute (eg preulcerative lesions, ulcers), or comprehensive (eg biomechanical, foot orthoses, footwear advice) which is most appropriate for maintaining the optimum level of comfort and function for the individual resident of that particular facility? – level of service may depend on issues of reimbursement and sources of funding,
• provision of facilities – eg the use of central treatment room or in patient’s own bed? (if ergonomically unsound potential for injury to Podiatrist)
• initial foot evaluation on admission care plan based on level of risk for foot complications and foot health status (done by Podiatrist or nursing staff?)
Gerontology Forum at Podiatry Arena