Who is the Family and Community Health Nurse? Who can the older person needing care and assistance turn to? Are there differences between the Italian social and health services and the Swiss ones? Let’s shed some light on the areas participating in the REACtion project – Piedmont and Canton Ticino.
Who is the Family and Community Health Nurse (IFeC)?
The Family and Community Health Nurse is a professional who takes care of promoting the wellbeing and health of the target community.
Unlike the hospital nurse, the IFeC operates in the local area and monitors the patient at home to improve their quality of life by providing needed care, social and health assistance, and support.
The IFeC ensures a continued and proactive presence. Besides addressing the health needs of the population and their patients, they also have the task of intercepting and preventing such needs from emerging. They do this by collaborating with all the resources available inside the community: families, volunteer associations, parishes, and neighbors.
They have specialized training in clinical care and management. They have expertise in the field of primary care, prevention, public health, care management and health monitoring. Finally, they use a patient-centered approach that requires empathy and interpersonal skills.
What do they do?
The IFeC performs various tasks inside a specific geographical area and target community. These include:
- Evaluating patient health needs
- Supporting the family and caregivers
- Proving health and socio-health services to their patients
- Formulating personalized care plans
- Administering treatment and monitoring treatment adherence
- Planning and integrating care strategies to avoid hospital admission
- Spreading the culture of prevention and promoting healthy lifestyles
- Facilitating ways to access these services and provide continued assistance
The IFeC is a reference person for the health of the entire population living in the urban and suburban areas of the target area. They provide social and health assistance at educational establishments and care residences for adults who are not self-sufficient. Besides this, they have a role of particular importance in the home assistance of older persons, children, and adults who are not self-sufficient, the chronically ill, vulnerable individuals and persons with disabilities.
The IFeC works in constant dialogue with all the social and health professionals and institutions that surround the patient: general practitioners, pediatricians, specialist doctors, social services, social and healthcare professionals, social welfare workers, the emergency medicine services, hospitals, clinics and various Case della Salute. Furthermore, they understand the older person’s environment and daily life, such as associations, groups, and social clubs. They support communication and connection between all actors of the social and healthcare network, in order to facilitate integrated and synergistic care in a multi-professional environment.
IFeC, what are the regulatory references?
Introduced and described by the World Health Organization in 2000, the role of the IFeC was officially established in Italy with the 2019-2021 Health Pact, approved by the State-Regions Conference on December 18, 2019. This pact represented a 3-year financial and program agreement intended to improve service quality, continued assistance, and the integrity of the National Health Service.
Prior to that, the IFeC system was already active in some ASLs of certain Regions, like Friuli-Venezia Giulia and Tuscany, but without any clear definition of the role and, most importantly, without formal recognition at the national level.
On May 13, 2020, the Relaunch Decree introduced the role of the Family and Community Health Nurse to increase the care of persons in the area infected by SARS-CoV-2. The provisions set out by the Decree took effect two months after the passage of Law 77/2020.
On September 10, 2020, the Conference of the Regions approved the Family/Community Health Nurse Guidelines Ex l. July 17, 2020 n. 77, a document that standardizes the IFeC figure in diverse regions, defining its responsibilities, contractual framework, and training.
In Canton Ticino (to which Locarno and Vallemaggia Districts belong), the figure of the IFeC is governed by the Law on home assistance and care (LACD) of November 30, 2010.
This law provides for the establishment of Home Assistance and Care Services (SACD), which includes all the organizations (public or private) and professionals that offer home assistance and care services. This system is also known by the acronym SPITEX, which means “Spital – externe Hilfe”, “Help outside the hospital”.
In each SACD of public interest there are various Operating Units, one for each area of operation. Each Operating Unit represents a versatile team composed of many individuals, including at least one designated nurse.
Who takes care of the older person that needs home support?
Home assistance for the older person is coordinated by the General Practitioner, who can forward a request to the Operations center for Home Care and Continuity of Care belonging to the patient’s ASL. The following services can be activated, according to the need:
- Planned Home Assistance (ADP)
- Home Nursing Service (SID)
- Integrated Home Assistance (ADI)
Older persons who do not need particular treatment but have lost self-sufficiency can make a request (directly or through family members, doctors, and caregivers) to the Unit of Geriatric Evaluation (UVG) to receive basic social and healthcare services. This Unit incorporates the ASL’s Integrated Home Assistance (ADI) services and Services of Home Assistance (SAD) of the person’s municipality of residence.
In the areas covered by the Districts of Locarno and Vallemaggia, home care and assistance are managed, like in all of Switzerland, by the SPITEX system. There are public Spitex (like ALVAD, partner of the REACtion project) and private Spitex.
If an older person requires home assistance, it is necessary to send a report to the Spitex team leader. The report may come from family members, the family doctor, an outpatient doctor, from the hospital where the person is admitted, or from a nursing home.
At that point the designated Spitex nurse takes on the patient and performs preliminary research of all the health and welfare providers the person may need. The nurse advises the attending physician and specialists following the patient, evaluates the actions to be taken, and activates all the various support systems: social healthcare workers, social workers, nursing assistants, caregivers, and volunteer organizations.
The services offered include health and socio-health services, such as:
- Home care and assistance, including hygiene and dressing
- Domestic home support, including cleaning, shopping and laundry washing
- Home meal services, transportation and accompaniment for medical appointments and shopping
- Rental of medical aids (crutches, inhalers, wheelchairs)
- Social assistance
KEY CONCEPTS – ITALY
Integrated Home Assistance - ADI
Integrated Home Assistance (ADI) is the combination of multi-disciplinary professional services (medical, nursing, rehabilitative, welfare) for people who need continued assistance and planned interventions on a repeated basis due to their serious health conditions. It includes home health assistance, from the ASL, and social services from the Municipality.
The General Practitioner activates these services upon the request of the patient, their family members, or caregivers.
Planned Home Assistance - ADP
Planned Home Assistance (ADP) is the basic welfare service that includes the delivery of medical, nursing, and/or rehabilitative services for a period of time that is limited to disease in course. It is directed at all the people who are unable to walk and reach the clinics for needed health services. The service is activated by the General Practitioner upon the request of the patient or their family members and caregivers.
Case della Salute
The “Casa della Salute” is a public structure that delivers multi-purpose health, socio-health, and social welfare services, to provide the citizen with the care and assistance that the hospitals are unable to handle.
Open 24/7, these structures were introduced by the Minister of Health in 2007 and are present today in many Italian regions, including Piedmont.
They perform nursing, diagnostic, specialist, residential, home and welfare functions through the multi-disciplinary integration of various professionals: general practitioners, specialist doctors from the main clinical fields, pediatricians, nurses, radiologists, obstetricians, physical therapists, psychologists, social workers, health workers.
They represent a local point of reference for primary care and assistance. They cater transversally to both the chronically ill patient and the acutely ill patient. They offer services to the civil society and the entire community by promoting specific prevention and health education programs.
The Nurse Case Manager (ICM) plays a role of integration and coordination in the “Casa della Salute”. Besides delivering nursing services, they determine care pathways, take on the chronically ill patient, and ensure continuity of care.
Home Nursing Service - SID
The Home Nursing Service (SID) offers exclusively nursing services, like medications, blood tests, catheterizations, management of stoma, and injective therapies. Service is delivered by the ASL for patients who are unable to reach the clinic.
The service is activated by the General Practitioner upon the request of the patient or their family members and caregivers.
KEY CONCEPTS – SWITZERLAND
Home Assistance and Care Services – SACD
Home Assistance and Care Services (SACD) comprises all the public and private organizations and independent workers who offer home care and assistance services. This system is recognized with the acronym SPITEX, which means “Spital – externe Hilfe”, “Help outside the hospital”.
In each SACD of public interest there are various Operating Units, one for each area of operation. Each Operating Unit represents a versatile team composed of many figures, including at least one designated nursThe SACD can be activated directly by the citizen or by their family members and caregivers by contacting the corresponding Spitex.
Social and welfare services, recognized by law as home care and assistance (LACD), has a key role in facilitating the older person’s stay at home and improving their quality of life.
For example, they provide transportation and accompaniment services to elder persons who cannot move independently, offer home meals, organizational and familial support to families, help with domestic tasks (cleaning, shopping, dressing), and organize recreational and social activities for older persons who are not self-sufficient.These services are generally activated by the specific Spitex that took on the elder person based on the recommendation of the General Practitioner, family members, outpatient doctor, nursing home or hospital.