Home Nursing Services

A principle objective for people with long term disability due to neurological disease, whether it be stable or progressive, is to live an independent life in the community for as long as possible. The neurological management of these patients aims to reduce their disability and consequent handicap within society. The most basic needs to allow independent living are access to information, advice and treatments from appropriate clinical specialists, counselling, housing, provision of aids and equipment, personal help, transport, and access to society.

It is the wish of most people to live at home. When resources are scarce, shifting the balance towards care in the community becomes increasingly important. The issues concerning the provision of domiciliary aids and care are complex and encompass individual wishes and the influences of society, as well as economic, social, and political issues. There are considerable variations in the provision of domiciliary services in different societies, and this chapter considers the problems from a United Kingdom perspective.

A wide variety of neurological disorders lead to severe disability. The assessment and provision of appropriate domiciliary support will depend on whether the disorder is stable (for example, congenital handicap such as some forms of cerebral palsy, stroke, traumatic paraplegia or tetraplegia, or head injury), progressive (for example, muscular dystrophy, motor neuron disease, or multiple sclerosis) or stable with late deterioration (for example, poliomyelitis, some cases of athetoid cerebral palsy).

The range of neurological disability which can be managed at home ranges from mild disability through immobility to complete dependence (with or without awareness). The practicality of maintaining patients in the home environment will be determined by the severity of the disability, the available infrastructure of aids and carers, and the cost of such an undertaking. A wide variety of specific severe disability can be satisfactorily managed in the home environment. These include immobility, severe impairment of limb function, cognitive function, communication, swallowing, breathing, and other activities of daily living.