Home care's contribution to alternative health care networks: deinstitutionalization and transformation of practices

To identify state-of-the-art home care within Brazil's public health system, evaluate its potential for improving the comprehensiveness and humanization of care, and identify areas for expanding this care modality. Seven home care initiatives were examined and cases were analyzed through interviews with five municipal services managers, seven service coordinators, all home-care team members, and with the service recipients, as well as the family members of the 27 cases selected. All of the interviews were recorded and transcribed. We also analyzed documents created by the home care services (policy manuals, management reports, evaluation reports, and care protocols), observed each team providing care (at least once for each of the seven service types), and analyzed the selected cases. The following types of home care were identified: palliative, AIDS, skin lesions/wounds, premature infant, bedridden patient, and supplemental intravenous antibiotic therapy for acute infection. The following positive aspects should be highlighted: the quality and humanization of care, team work, the bond developed with patients and family, the sense of responsibility taken on by the health workers, and the effective participation of caretakers and families in carrying out therapy plans. The initiatives examined show that home care is possible even in economically disadvantaged environments and that it may effectively contribute to providing integrated and continued care. Home care should be expanded in the context of the public health system.