Home care is defined as the service designed to provide assistance at home by healthcare professionals as well as families, also known as informal carers, to patients with chronic and non-healing wounds. Home care associated with the healthcare system has become a growing trend around the world for several reasons. The purpose of home care for chronic wounds can range from being merely supportive of palliative to rehabilitative. Palliative care is solely dealing with the wound and taking care of the pain without the primary cause being treated. Rehabilitative care aims at restoring the functional capability of the chronically wounded patient to the maximum.
Introduction to wounds
Skin is the largest organ of the human body. Discontinuation in this physical protective barrier results in a wound that may be classified into different types based on their characteristics and cause. It is important to understand wound etiology along with the duration and mobility of the patient himself in order to provide the best possible care.
An abrasion is a wound inflicted when the surface of the skin rubs against a rough surface. This type of wound does not bleed much. Road rash is a common type of abrasion. The only management attention this wound needs is for cleaning and disinfecting in order to avoid any bacterial invasion through the breach leading to an infection.
Laceration wounds are inflicted by the use of knives or any sharp object. They cause deep cuts and tears of the skin and underlying tissue. Deep lacerations may lead to excessive loss of blood which is resultantly harmful.
Puncture is a wound created in the shape of a hole. The objects causing puncture wounds are usually long and pointed such as nails or needles. This type of wound may not bleed as much but is very likely to involve damage to deep internal organs.
An avulsion is a partial or complete tearing away of the skin and the underlying superficial tissue. The skin and tissues are avulsed away from their surface in explosions, roadside accidents crushing bodies and even gunshots. This type of wound usually bleeds heavily.

Surgical Wound
Surgical wound results from a cut or incision made on the skin using a surgical instrument such as a scalpel during a surgical procedure. Depending on the type of surgery and breach to be made, the surgical wound varies in size which may be left open or sutured for closure. Patients are usually discharged from the hospitals before the surgical wound has fully healed. This necessitates the availability of home care. Home care for surgical wounds implies frequent changing of dressings and maintaining the cleanliness of the wound to prevent infection at the site where the wound may last for weeks and months on end if not properly taken care of. Home care for surgical wounds has specially been stressed because the patients recovering from surgery are usually bedridden and cannot show up at the clinics for routine dressing and follow-ups.

The home care for the above-mentioned wounds especially caters to the wounds that can be categorized as chronic. Wounds that have failed to progress through the phases of skin and tissue healing even for the duration of 30 days are characterized as chronic wounds. Also, the venous, diabetic and pressure ulcers, with respect to the etiology, are characterized as chronic ulcers. There are multiple factors that contribute to the non-healing of the wounds. Especially the wounds that are on the lower extremities or have been infected further by a pathogen, take a longer time to heal. Wound care at home deals with overcoming these factors that delay the healing process and minimizing the discomfort.
Home care for chronic wounds
The chronic wounds are usually not catered to at the hospital and the home care for these wounds is advised. With better education and counseling, the center of care for the chronic wound has significantly shifted from hospital settings to home care. The growing trend of home care services for the patient promises many benefits. Not only is the patient guaranteed to have an exclusive management plan with better quality but the patient’s safety from being exposed to hospital-acquired diseases is also indicated. This significantly favors the population of aged people who are bedridden and constantly need undivided care from either their family members or hired help from healthcare professionals. The increased prevalence of chronic health concerns such as obesity, cardiovascular diseases and diabetes resulting in chronic wounds has also led to a noteworthy shift in the healthcare services for wound care at home away from hospitals.

It is important for taking care of a wound at home to deeply understand the steps and the precautions involved in this process of regular wound care, especially the non-healing wounds within the premises of their own home. Not only the underlying cause, but the duration of the wound and the overall effect on mobility and quality of life of the patient are to be taken into consideration for more effective management and care of the patient.

The outreach of the healthcare system providing wound care services at homes includes nurses specifically called the Tissue Viability Nurses (TVNs), podiatrists and a number of healthcare assistants in a multidisciplinary approach. Covering the areas of chronic pressure ulcer management, the role of a physiotherapist and an occupational therapist is also being developed as the population requiring assistance with mobilization of joints around non-healing ulcers grows. After the wound and its etiology is diagnosed by a respective qualified specialist such as dermatologist, diabetologists, and surgeons, the TVNs may further continue to lead in order to provide guidelines and educate the sufferer and attendants about regular patient care.
Furthermore, living with a chronic wound and regularly monitoring it means that the communication and understanding between the patient and healthcare worker is the key. The development of this good interpersonal relationship is also the key to better therapeutic care and directly enhances the quality of care.
The current healthcare system concerning wound care is developing and improving rapidly. With the increased life expectancy and growing prevalence of chronic diseases like diabetes and cardiovascular diseases, the group of aged population and population with non-healing complicated ulcers from these diseases is also growing. This population prefers to live inside their homes and require the provision of services within their residences as their dependency grows, the specialized wound care at home has been augmenting within the communities all around the world. Not only the dressing of the wound and the material required like the special footwear for the diabetics, the services of physiotherapy and rehabilitation are also being considered for the ambulatory services of the healthcare system inside the homes with the blooming trend. Although this comes with its challenges of no direct monitoring at all times, this home care service promises improved quality of life for the patient as well as a reduced burden on the hospital beds for the cases that can conveniently be dealt with at home.
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2. RN S DClinPrac P, RN S MNsc S, Gerber V, Care PD, Gethin D. EWMA Document: Home Care-Wound Care: Overview, Challenges and Perspectives. Journal of wound care. 2014 May;23:S1-41.
3. Terry M, Halstead LS, O’Hare P, Gaskill C, Ho PS, Obecny J, James C, Lauderdale ME. Feasibility study of home care wound management using telemedicine. Advances in skin & wound care. 2009 Aug 1;22(8):358-64.C

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