INTRODUCTION

Home Health Care is skilled nursing care and certain other health care services that you get in
your home for the treatment of an illness or injury. This page explains Medicare’s basic home
health benefit and gives you information about where to get more information and help.

How Can I Get Care at Home?

To get home health care:

1. Your doctor must decide that you need medical care in your home, and make a plan for
your care at home; and
2. You must need at least one of the following: intermittent (and not full time) skilled
nursing care, or physical therapy or speech language pathology services; and
3. You must be homebound. This means that you are normally unable to leave home. Being
homebound means that leaving home is a major effort. When you leave home, it must be
infrequent, for a short time, or to get medical care; and
4. The home health agency caring for you must be approved by the Medicare program.

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HOME HEALTH CARE IN INDIA
The Indian healthcare sector has been growing at a frenetic pace in the past few years. The
windfall began ever since the developed world discovered that it could get quality service for
less than half the price.

The sector is expected to post the highest year-on-year growth in earnings in the fiscal year to
March 31, 2007. It is set to post a 42 per cent rise in earnings in the year to March 2007. These
figures are driven by availability of quality healthcare and the huge rise in numbers visiting India
for treatment.

The number of patients visiting India for medical treatment has risen from 10,000 in 2000
to about 100,000 in 2005. With an annual growth rate of 30 per cent, India is already
inching closer to Singapore, an established medicare hub that attracts 150,000 medical
tourists a year.

The healthcare industry employs over four million people, making it one of the largest service
sectors in the economy. A joint study by the Confederation of Indian Industry and McKinsey
shows: ·

 At the current pace of growth, medical tourism, currently pegged at US$ 350 million, has
the potential to grow into a US$ 2 billion industry by 2012.
 Healthcare spending in the country will double over the next 10 years. Private healthcare
will form a large chunk of this spending, rising from Rs 690 billion (US$ 14.8 billion) to Rs
1,560 billion (US$ 33.6 billion) in 2012. This figure could rise by an additional Rs 390
billion (US$ 8.4 billion) if health insurance cover is available to the rich and the middle
class.
 The voluntary health insurance market, which is estimated at Rs 4 billion (US$ 86.3
million) currently, is growing fast. Industry estimates put the figure at Rs 130 billion (US$
2.8 billion) by 2005. ·
 With the expected increase in the pharmaceutical market, the total healthcare market
could rise from Rs 1,030 billion (US$ 22.2 billion) currently (5.2 per cent of GDP) to Rs
2,320 billion (US$ 50 billion)-Rs 3,200 billion (US$ 69 billion) (6.2-8.5 per cent of GDP)
by 2012.

However, it is not only the cost advantage that keeps the sector ticking. It has a high success rate
and a growing credibility.

 Indian specialists have performed over 500,000 major surgeries and over a million other
surgical procedures including cardio-thoracic, neurological and cancer surgeries, with
success rates at par with international standards.
 The success rate in the 43,000 cardiac surgeries till 2002 was 98.5 per cent.
 India's success in 110 bone marrow transplants is 80 per cent.

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 The success rate in 6,000 renal transplants is 95 per cent.

 India's independent credit rating agency CRISIL has assigned a grade A rating to super
specialty hospitals like Escorts and multi specialty hospitals like Apollo.
 NHS of the UK has indicated that India is a favored destination for surgeries. · The
British Standards Institute has now accredited the Delhi-based Escorts Hospital.
 Apollo Group - India's largest private hospital chain and Wockhardt Hospital are now JCI
accredited.

KEY PLAYERS IN HOME HEALTH CARE SERVICES

 Wockhardt Hospital, Mumbai

 Medanta – The Medicity
 Artemis Health Institute (AHI), at Gurgaon

 Metro Hospitals & Heart Institute

 Columbia Asia

 Indian Spinal Injuries Centre

 Kerala Institute of Medical Sciences(KIMS), Trivandrum

 Indicure

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SWOT ANALYSIS OF HOME HEALTH CARE SERVICES

STRENGTH:

1. Compliance code of ethics of hospital health care providers.

2. Periodically evaluation for nurses staffs.
3. Availability of inservice education programs
4. Health care provider's development (physicians, nurses, multidisciplinary team).
5. Good interdisciplinary working place social support.
6. Availability of the hospital infrastructures.
7. Availability of computer tempography CT scan device .
8. Strong informal communication channels among hospital departments.

WEAKNESS

1. Low commitments of hospital polices and regulations.

2. Lack of resources support (time, money, and support) for development.
3. Few numbers of RN's comparing with practical nurses.
4. No competition especially among nurses themselves and other health care
providers.
5. Lack of work innovations and creativity work atmospheres.
6. Understaffed departments and high workload on hospital staffs
7. Too much of trial and error toward problem solving.
8. Inability of some nurse department's managers to empower their followers.
9. Miscommunication about role of other hospital departments or units within
staff expectations about potential levels of collaboration and support.
10. Too much duplication of and not up to date inservices education department courses, each
course doesn’t always need, it already presented previously.
11. Overlapping duties of nursing staffs
12. Insufficient rewards and recognition for nurse's staff.
13. Centralized structure of hospital administration.
14. Lack of visibility and transparency regarding to inappropriate behaviors.
15. Lack of practices that depend on evidence based practice.

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OPPORTUNITIES

1. Strong relationships and form of collaboration with other governmental

hospitals and health departments.
2. Location of hospital serves large population, more available connections, and
resources.
3. Easy of the public transportation to the hospital.
4. Ability to expand in hospital departments and health care services.
5. Opportunity to Create training program and courses in health by collaboration
with the health faculties that trainee their students in the hospital.

THREATS
1. Low staff income in comparison with other private hospital sector.
2. Unavailable good community outreach initiatives.
3. Lack of technology advancement and updated devices.
4. The inability to attract and retain nursing staff due to lower salaries.
5. Nurses' staff recruitment process derived from Ministry Of Health.
6. Insufficient of central funding resources.
7. Lack of external fund resources for development of nurses and other
hospital employees.
8. High nurse salaries in other countries.
9. Nursing shortage.
10. Lack of information technology system.
11. Lack of Internet resources (i.e., search engines, online journals).

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CASE STUDY – INDICURE LIMITED
Indicure is a limited company, founded by a group of medical and management professionals
with an objective to provide customized patient care management services in India for medical
tourism.

It follow a personalized approach to understand a client's healthcare needs and need for support
services of nursing, accommodation and transportation in India. We suggest, design and deliver
healthcare services according to the client's special needs. We also lend an unbiased opportunity
to compare various medical options in India with the convenience of availing skilled nursing,
home healthcare services in India, travel and accommodation services under one roof.

The customized services are specially focused towards medical tourism in India.

Indicure conducts its own research on the various medical facilities and medical professionals to
associate with the best. A rigorous and non compromising quality checks proceed before we
associate with any of the institutions or professionals in India.

Indicure has preferential association with chosen few centers of medical excellence in India, and
work closely with them to deliver world class healthcare services. Our experienced and qualified
nurses and therapists lend us the capabilities to deliver customized services. With
accommodation and transportation solutions offered as a package, we have the resources to be a
seamless provider for Medical Tourism in India.

Indicure provides quality and compassionate home healthcare services to the families and elderly
in India in the comfort and security of their home environment. We help patients with healing
after surgery, learning to walk again after an accident, regaining speech after a stroke, getting to
and from doctors' appointments, and recovering after a heart attack. We have the expertise and
capabilities to provide a full range of home health care services in Delhi and NCR.

The team of licensed professional medical staff is knowledgeable and dedicated to excellent,
compassionate care for patients, clients, and their families. Our services are tailored to meet your
or your loved one's specific needs for health recovery and maintenance.

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MISSION

To be a pioneer and leader in Patient care management services in India to make the entire
process of seeking healthcare services completely hassle free for patients and their loved ones
thereby allowing them to concentrate on their recovery and better health.

GUIDING PRINCIPLES

Achieve the best possible outcome for each patient

Embrace a customer service philosophy
Work together as a team towards common goals
Maintain the highest ethical standards.

VALUES

As the pioneer organization in providing high quality patient care management services, we
solicit our commitment to our customers, members, co-workers, and our organization. We abide
by our uncompromising values of Safety, Excellence and Trust, which are key to our ability to
fulfill our commitments. Our values are the fundamental part of our lives, and guide our
decisions and actions every day.

 Safety
Medical institutions we choose to partner with comply with the internationally accepted
standards. Our internal quality standards and their continual monitoring guide us in
associating with best to ensure Safety for our clients.

 Excellence
Medical Experts we choose to partner with are crème de la crème of Indian medical
fraternity and have a proven track record of Excellence in their respective medical fields.
Our continued medical education programmes ensure that our professionals are best trained
and are equipped with the latest.

 Trust
All the information shared with us by our clients and network partners is treated with
utmost sensibility and confidentiality; and the foundation for a long-term relationship with
them is of Trust. We solicit correct information, and make it our utmost endeavor to furnish
correct information to the best of our knowledge.

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 HOMEKURE

Home is the appropriate place to deliver medical services to those persons who wish to remain
independent or have the need for specific care that is beyond the scope and ability of family and
friends to provide. Homekure provides a coordinated system of comprehensive, multidisciplinary
health care services in the home environment to promote, maintain and/or restore health, and
minimize the effects of illness and disability.

Our customized services enable the elderly, chronically ill, disabled and recuperating patient to
receive medical treatment in the comfort and privacy of their home where their surroundings are
more conducive to recovery.

HOMEKURE SERVICES INCLUDE:

Post Hospitalization Care

Healthcare services required after an operation or hospitalization

Rehabilitation Therapy
Physical, Occupational and Speech therapy

Hospice Care
Compassionate medical and emotional care for a person with terminal illness

Specific Medical Conditions

Packaged programs for specific, acute and chronic conditions such as Stroke, Spinal Cord
Injuries, Muscular Dystrophies, Disc Prolapse etc.

 Child Care
 For managing conditions in children like Cerebral Palsy, Spina Bifida and other
Congenital Disorders

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POST HOSPITALISATION CARE

Homekure provides expert and compassionate post hospitalization care, which includes both the
nursing and rehabilitation services. A nurse may be required to take care of the specific medical
needs of a patient who has just returned home from the hospital after a surgery. Or a person who
is recovering from a stroke needs rigorous rehabilitation therapy.

Skilled Nursing

Skilled nursing services are provided by professionally trained nurses in accordance with the
defined plan of care given by the physician and include the following:-

 Medication Management
 IV therapy
 Wound care/ Ostomy care
 Understanding a new disease process or diagnosis
 Teaching a patient or family to achieve their highest level of independence.
 Ensure safety
 Promote recovery

REHABILITATION THERAPY

The goal of Homekure rehabilitation services is to help patients and their families return to as
complete and rich a life as possible. Our pre and post therapy programmes are specially designed
to help patients recover faster by starting their therapy before their surgery begins.

Our qualified physical therapists, occupational therapists and speech therapists are licensed
professionals from reputed institutes and work in close coordination with the patient's physician,
home health care nurse, and other disciplines. They have expertise in dealing with the patients
recovering from orthopedic or cardiac surgery, injuries, neurological disorders, and many other
types of health problems to help them achieve their maximum level of functioning.

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Physical Therapy:

Physical Therapists specialize in treatments that improve the mobility and physical strength of
patients. Physical therapy primarily consists of physical exercises to alleviate pain and restore
muscles along with patient education to improve mobility. Physical therapy is delivered in
accordance with the physician's defined plan of care. The following are examples of physical
therapy provided in the home:

 Assisting with ambulation, transfers, muscle weakness, tremors, spasticity or joint

stiffness
 Range of motion (ROM) and positioning
 Exercise programs
 Assistance with respiratory problems

Occupational Therapy:

Occupational Therapists specialize in treatments that enable patients to perform the general
activities of daily living (ADL's) s. Using fine motor, cognitive, perceptual and sensory exercises
and tasks, our occupational therapists help patients regain daily living skills.

Generally individuals who have physical, developmental and/or social problems might need the
skills of an Occupational Therapist. Occupational therapy is delivered in accordance with
physician's defined plan of care.

The following are examples of occupational therapy provided in the home:

 Assist with safety concerns that may stem from sensory impairment.
 Assist with perceptual motor difficulty, coordination problems, and muscle weakness
 Assist with energy conservation

Speech Therapy

Our speech therapists specialize in treatments that aid patients to restore speech that may have
been lost due to some form of trauma, for example a stroke or initiate speech in children who
haven't started speaking yet for example cerebral palsy. Speech therapists also train patients to
improve their breathing and swallowing. Speech therapy is delivered in accordance with
physician's orders and as defined in a plan of care.

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The following are examples of speech therapy provided in the home:

 Assist with communication difficulty

 Treat swallowing disorder and the side effects that are associated with the swallowing
disorder
 Improve and restore lost language function and ability

HOSPIC CARE INDIA

More and more people are choosing their home as the place to spend the last months of their
lives. The patient feels secure and comfortable in the familiar surroundings and can be with his/
her loved ones.

Homekure provides Hospice Care program for patients who are terminally ill or end of life care
to elders. Our program gives patients and their families time together at home, enabling them to
make the most of each day.

Our team works together with the patient, family, the patient's physician to: -

Achieve Comfort - Working closely with the patient's own physician, our hospice team
evaluates and manages any pain or symptoms. The team coordinates a plan of care while our
physicians make home visits in consultation with the patient's primary physician if required The
team coordinates a plan of care while our physicians make home visits in consultation with the
patient's primary physician if required.

Provide Support -A few words of assurance and counseling at such hour can bring a lot of relief
to both the patient and family members. We understand that the loss is irrecoverable, but the
emotional support and counseling by our psychologist can definitely help the patient and the
family.

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SPECIFIC MEDICAL CONDITION

Packaged programs for specific, acute and chronic conditions such as Stroke, Spinal Cord
Injuries, Muscular Dystrophies, Disc Prolapse etc.

Homekure provides intensive therapy for various orthopedic and neurological conditions. in the
home setting of the patient, once the patient is discharged from the hospital. The treatment
protocol is designed as per the condition of the patient and is tailor made and customized to the
specific condition of each patient. The patient care starts from day one uptill the maximum
recovery possible. It is always advisable to start the therapy as early as possible for best results.
Homekure services can be availed for the following conditions:-

Neurological Conditions: -

 Stroke / Hemiplegia
 Head Injury
 Spinal Cord Injuries

o Quadriplegia
o Paraplegia

 Parkinsonism
 Muscular Dystrophies
 Motor Neuron Disease
 Meningitis
 Movement Disorders
 Multiple Sclerosis

Orthopedic Conditions:-

 Total Joint Arthroplasty

 Fractures
 Bone Tumors
 Disc Prolapse
 Arthritis

o Osteoarthritis
o Rheumatoid Arthritis

 Ankylosing Spondylosis
 Amputations
 TB of bones and joints
 Peripheral Nerve Injuries

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CHILD CARE

This involves complete care of children with problems like Cerebral Palsy, Spina Bifida, Autism
spectrum disorder (ASD) and others

We have a team of skilled professionals qualified in Pediatric care comprising of :

 Physician - Pediatric neurologist, pediatric physiatrist

 Orthopedician
 Clinical Psychologist
 Occupational Therapists
 Physical therapists
 Developmental therapists
 Speech therapists
 Prosthetic Orthotic engineers
 Special educators

The physician works with the team of professionals first to identify a child's unique needs and
impairments and then to create a customized treatment plan that addresses them.

Some approaches that are included in our treatment plan are drugs to control fissures and muscle
spasms, special braces to compensate the muscle imbalance, surgery, mechanical aids to help
overcome impairments, counseling for emotional and psycho logic needs, and physical,
occupational, speech and behavioral therapy.

In general, the earlier treatment begins, the better chance the child has of overcoming
developmental disability or learning new ways to accomplish difficult tasks.

We practice the holistic approach in treating these children and work in the direction of both
cognitive as well as physical development.

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STRATEGIES:

The service strategy of the company is it provide service STEP BY STEP

Step 1

Submit Enquiry Form to Indicure.

You or your loved one can submit a query for availing a Homekure plan with the choice of plan
and any special requirements through HHC Query Form.

You can either fill the form or submit medical reports online or can fax them at
+91 11 25 27 24 00.

Step 2

Physician Referral and Customized Healthcare Plan

Depending on the medical condition of the patient, the case is discussed by our core team to
recommend a medical specialist who can best handle the particular case. After consultation with
our medical specialist, a complete healthcare plan is designed for the patient to be served in the
home environment.

If you or your loved one has any healthcare plan suggested by your physician, the same can be
administered in the home environment. Indicure shall require the physician's prescription in such
a case.

Step 3

Make Payment

Depending on the customized healthcare plan, Indicure shall communicate the payment
schedule. The payment can be made in India in INR in cash or through Cheque payable in Delhi.
Payment from overseas can be made in foreign currency (USD, GBP, and EURO) through online
remittance or wire transfer/telegraphic transfer.

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Step 4

Service Delivery and Supervision

The agreed on customized healthcare services with any special requirements are delivered by the
care provider (licensed nurse/ physical therapist/ occupational therapist/ speech therapist) in the
comfort of home. Indicure shall regularly keep in touch with your physician/ our expert and
monitor the services delivered. A case sheet is made and the daily health report is recorded and
monitored.

Indicure shall keep in touch with the subscriber and update him/ her regularly about their loved
one's health.

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REFERENCES:
o www.indicure.com
o www.wikepidia.com
o www.google.com
o www.marketresearch.com

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