Healthcare is and always will be a lucrative business opportunity and an exciting arena for scientists as human bodies not only deteriorate with age, but battle to cope with lifestyle changes and environmental wear and tear from exposure to radiation, pollution and the climate extremes of our planet.

Hospitals today have become more highly intensive in terms of their care environments than in the past and therefore the cost of in-hospital care has escalated considerably.

It is thought preferable to treat less-acute patients outside of the institutional environment whenever possible, because it uses resources more effectively and often provides more effective care. With this in mind, managing one’s health following hospitalisation is a high priority.

Many people would prefer to recover from an illness or surgical procedure in the comfort and privacy of their own homes and of course patients are also eager to resume their prior activities and lifestyles. It has been noted that with in-home care, patients recover more quickly, experience better outcomes and are more satisfied with the experience. However, additional assistance and teaching may be needed to regain safety and independence as they return home.

Evaluation and resources
It has been shown that a person recovering from surgery or a serious illness requiring hospital treatment is going to need a skilled team of specialists and specialised equipment to provide adequate home care.

Firstly, occupational and physical therapists will need to assess their patient’s physical ability to function independently in their home environment. The safety and accessibility of the home is assessed and recommendations provided to improve certain functions.

Occupational therapists (OT) assess self-care skills such as dressing, bathing, and eating as well as more complex tasks such as meal preparation and light housekeeping. Physical therapists (PT) evaluate activities of daily living with a focus on safety, mobility, balance, and endurance.

Homecare services are usually provided by homecare organisations, but may also be obtained from registries and independent providers. Homecare organisations include home health agencies, hospices, homemaker and homecare aide agencies, staffing and private-duty agencies, and companies specialising in medical equipment and supplies, pharmaceuticals, and drug infusion therapy.

Several types of homecare organisations may merge to provide a wide variety of services through an integrated system. After determining functional limitations, homecare therapists develop treatment plans to address environmental, musculoskeletal, neurological, cognitive, and/or psychosocial issues that are impacting safety and independence.

Examples of OT interventions include adaptive self-care techniques, strategies to compensate for cognitive (mental functioning dealing with learning and reasoning) impairment, energy conservation, and strengthening, Examples of PT interventions include transferring from one location to another (bed to wheelchair for example), walking, and stair training, as well as progressive strengthening, balance strategies, and lymphedema (swelling) management.

Both are skilled in providing therapy methods for pain management, home exercise programmes, adaptive equipment recommendations and client/caregiver education.

Remote monitoring
Home health monitoring and telemedicine for post-discharge care are nothing new with cardiovascular care, but it is taking on added dimension to assist patients who suffer from chronic or long-term medical conditions like cancer or diabetes, whose vital signs can suddenly fluctuate and that historically require frequent visits to the hospital.

The concept of telemedicine is expected to expand with the spectre of ‘Baby Boomers’ approaching retirement, a trend that will dramatically increase the elderly population.

It is also thought that the next generation of home health monitoring will take consumers beyond routine pacemaker monitoring and into total remote monitoring. The business value of this new direction goes beyond the desire to reduce hospitalisation, and therefore cost, and extends to better resource utilisation in an era of nursing and other workforce shortages, the need to better manage chronic diseases, and the desire for better patient service and outcomes.

The use of technology to convey information between patients and caregivers has evolved past phones and fax machines and internet solutions now allow patients to schedule appointments and communicate with their doctors. Several new technologies have created a surge in the field of home health monitoring, offering patients a chance to be watched and cared for without the need to visit a hospital every time they have a problem.

Beyond monitoring systems clinics, are developing other devices to improve patient care, for example the MD-2 personal medication system developed by Aurora Healthcare in the US. This coffee-maker-sized device is programmed to dispense medication on a schedule of up to six times every 24 hours and is linked to the healthcare provider’s computer system. It immediately sends a signal if the medication is not taken and can be set up to contact three other providers if there is no response.

Device development will continue the trend of merging these functions into a single device. Multifunctional devices like these would allow healthcare providers to consolidate operations leading to wider adoption by insurance companies. The biggest obstacle, it seems, is the lack of an infrastructure to monitor and detect the data. Without an appropriate recording system the data collected cannot be compared to normal health criteria and therefore is of limited use to doctors and other providers.

Sources of equipment
Durable medical equipment and supply dealers are able to provide homecare patients with products ranging from respirators, wheelchairs, and walkers, to catheter and wound care supplies.

These dealers sometimes employ staff who deliver and, when necessary, install these products as well as instruct patients on their proper in-home use. Durable medical equipment and supply dealers usually do not provide physical care for patients, but there are a few exceptions.

Some dealers offer pharmacy and infusion services, where a nurse administers medication and nutritional formulas to patients and teaches them the proper techniques for self-administration. Some companies also provide respiratory therapy services to help individuals use breathing equipment.

Patients who require respiratory therapy at home have diagnoses such as emphysema, chronic bronchitis, asthma and compromised heart function. These patients are provided with home oxygen systems, nebulizers and aerosol medications. A growing population of obstructive sleep apnea sufferers are provided with Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP) equipment and supplies.

Patients who require infusion therapy may have diagnoses such as infections, multiple sclerosis, cancer and cancer-related pain, gastrointestinal diseases or disorders such as Crohn’s disease or esophageal cancer, that result in nutrition-related problems, congestive heart failure, and immune disorders.

The world of medical homecare requires numerous devices to be designed, built or improved. This presents endless business opportunities because of the enormous numbers of patients and caregivers involved.

Homecare provided by the industrial gases industry
In the industrial gases industry Air Liquide appears to have taken the lead by investing resources to develop and market products and services dedicated to homecare applications.

Globally, up to 6,350 Air Liquide staff members are devoted to healthcare, serving 6,000 institutions and well over 300,000 homecare patients in 35 countries around the world.

In 2010 the reported earnings of its Homecare business was close to €1bn, representing over 40% of its total Healthcare business worldwide.

Strategy & prospects
The group’s Healthcare world business line provides medical gases, hygiene products and related medical equipment to many of the world’s hospitals. Gases are used, for example, for anaesthesia, assisted ventilation and easing certain pains.

Air Liquide is spearheading the fight against nosocomial infections by conducting research to develop highly effective targeted products for the skin, hands, instruments and surfaces.

In 2010, Air Liquide strengthened its presence in the health sector through targeted acquisitions in Europe, Asia, and South America. The group will continue to pursue this strategy over the next five years. The strategy will help Air Liquide reach the goals it has set for 2015, which includes the provision of homecare to one million patients.

The rapid growth in homecare needs has been spurred by the world’s ageing population, the development of chronic diseases, the emergence of new technologies, budget pressures pertaining to public policy, and above all, the desire of patients to receive care at home.

Air Liquide, the European leader in this field, cares for more than 600,000 chronic patients, primarily in Europe, by providing set-up and follow-up services involving:

• Respiratory assistance (oxygen therapy for severe cases of chronic obstructive pulmonary disease, ventilation for chronic respiratory failures, continuous positive airway pressure for sleep apnea)

• Nutritional assistance and infusion therapy

• Insulin pump therapy for diabetes.

Homecare – Geographic expansion
The leading European player in the homecare market, Air Liquide has confirmed its development strategy in this consistently growing field by acquiring two companies in Australia and South Korea.

In July 2010, Air Liquide acquired 70% of Snore Australia; a company specialised in sleep diagnostics.

These diagnostics help identify and assess the degree of symptoms for sleep apnea patients. An estimated 480,000 Australians suffer from this disorder, while only 25% of cases have been diagnosed to date. This company, created in 2000, owns 13 laboratories, where it performs over 15,000 sleep diagnostics per year. Its annual revenue stands at €6m.

Air Liquide also acquired 70% of the company Medions Homecare, the South Korean leader in home ventilation. Created in 1989, Medions Homecare handles follow-up for about 400 patients. Its annual revenue is €3m in a Korean homecare market marked by more than 15% annual growth.

With more than 300 million people affected in 2010 and an estimated 400 million by 2030, diabetes has been called the ‘epidemic of the 21st century’ by the World Health Organisation (WHO). Buoyed by its position as leader in homecare, Air Liquide answers the call to care for patients suffering from multiple chronic diseases and requiring respiratory assistance (sleep apnea and diabetes, for example).

As such, in just a few years, the group has become a major player in France in providing homecare to diabetic patients using insulin pumps.