Home-care suitability assessment

Currently, in the majority of Australian regions, home-care suitability is determined by public health units/state or territory health services or commissioned providers and the local hospital-supported community care processes. GPs, local hospital services, PHNs, public health units and commissioned health services should collaborate in determining an individual’s home-care suitability. GPs can seek advice and support from these services, as required. See - Determining the appropriate monitoring protocol.

Models of care might include GP shared care for patients being supported in a hospital-led program, or full GP management without hospital involvement. Both models provide an important measure to ease pressure on the hospital system. The principles remain the same, irrespective of the model.

The following factors are currently used to determine location of care and care protocol and align with the National COVID-19 Clinical Evidence Taskforce guidance on Pathways to Care.

Refer to boxes 1 and 2 for the current disease severity definitions.*

Currently, the majority of patients cared for in the community have mild illness and most will not require additional support. GPs are increasingly caring for people with mild-moderate symptoms who are at risk of more severe illness. The ability for general practices to provide care for moderately ill patients will depend on access to, and availability of, tertiary health services, clinician’s own abilities and capabilities and the patient’s willingness to be cared for in hospital.

There might be circumstances where, by choice of the patient or where access to hospital services is limited, GPs could be caring for severely ill people in the community. This guide does not provide guidance for care of severely ill patients in the community. Care of severely ill patients should be in collaboration with a hospital-led service.

*Local HealthPathways might use different criteria to define disease severity.
 

 Box 1. Definition of disease severity for adults
Mild illness An individual with no clinical features suggestive of moderate or more severe disease:
  • no OR mild symptoms and signs (fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhoea, loss of taste and smell)
  • no new shortness of breath or difficulty breathing on exertion
  • no evidence of lower respiratory tract disease during clinical assessment or on imaging (if performed)
 
Moderate illness A stable patient with evidence of lower respiratory tract disease:
  • during clinical assessment, such as
    • oxygen saturation 92–94% on room air at rest
    • desaturation or breathlessness with mild exertion
  • or on imaging
 
Severe illness A patient with signs of moderate disease who is deteriorating
 OR
A patient meeting any of the following criteria:
  • respiratory rate ≥ 30 breaths/min
  • oxygen saturation < 92% on room air at rest or requiring oxygen
  • lung infiltrates > 50%
 
Critical illness A patient meeting any of the following criteria:
  • Respiratory failure (defined as any of)
    • severe respiratory failure (PaO2/FiO2 < 200)
    • respiratory distress or acute respiratory distress syndrome (ARDS)
    • deteriorating despite non-invasive forms of respiratory support (i.e. non-invasive ventilation [NIV], or high-flow nasal oxygen [HFNO])
    • requiring mechanical ventilation
  • hypotension or shock
  • impairment of consciousness
  • other organ failure
 
Reproduced with permission from National COVID-19 Clinical Evidence Taskforce. Australian guidelines for the clinical care of people with COVID-19. 2022 (version 57.1). Check for updates in the Taskforce’s Living Guidelines
Box 2. Definition of disease severity for children and adolescents
  Feeding/hydration/conscious state
 
Respiratory/vital signs Oxygen requirement
 
Mild illness Normal or mildly reduced feeding No or mild upper respiratory tract symptoms
OR
No or mild work of breathing
 
Moderate illness Poor feeding, unable to maintain hydration without nasogastric or IV fluids
AND
Normal conscious state
Moderate work of breathing OR
Abnormal vital signs for age (tachycardia, tachypnoea), but does not persistently breach early warning criteria (eg medical emergency team [MET])
OR
Brief self-resolving apnoea (infants)
Requiring low-flow oxygen and/or with chest x-ray changes due to COVID-19 without other severe features
Severe illness Poor feeding, unable to maintain hydration without nasogastric or IV fluids
OR
Drowsy/tired, but easily rousable
Moderate–severe work of breathing
OR
Abnormal vital signs for age (tachycardia, tachypnoea) with breaches of early warning criteria (eg MET)
OR
Apnoea needing support/ stimulation (infants)
Requires high-flow oxygen or non-invasive ventilation
Critical
illness
Poor feeding, unable to maintain
hydration without nasogastric or
IV fluids
OR
Altered conscious state/
unconscious
Unable to maintain breathing or
prevent apnoea without advanced
modes of support
OR
Abnormal vital signs for age
with persistent breaches of early warning criteria (eg MET)
OR
Haemodynamically unstable without inotropic or vasopressor support
OR
Other organ failure
Requires advanced modes of
support to maintain oxygenation
 
 
 
Intubation and mechanical ventilation
OR
Extracorporeal membrane oxygenation
Reproduced with permission from National COVID-19 Clinical Evidence Taskforce. Australian guidelines for the clinical care of people with COVID-19. 2022 (version 57.1). Check for updates in the Taskforce’s Living Guidelines.
  • Is the patient up-to-date with their COVID-19 vaccinations (therefore less likely to develop severe disease) or recent confirmed infection with SARS-CoV-2?
  • Does the patient have any risk factors for adverse outcomes or severe COVID-19? (Refer to Box 4.)
  • What other health conditions need to be monitored and managed?
  • Are there any cultural or social factors that might affect help-seeking, treatment and the ability to isolate?
  • Does the patient have any drug or alcohol dependencies that need management so they can effectively isolate?
  • Does the patient have any mental health issues that might affect their ability to isolate or be significantly worsened by isolation?
  • Does the patient or their carer have an adequate understanding of their illness and the risk of deterioration (health literacy)?
  • How easily can the patient be moved if their condition deteriorates?
  • Does the patient have a preference for home or hospital-based care?
  • Are other members of the household vaccinated against COVID-19?
  • Does the patient have suitable accommodation and access to food, medicines and essential supplies?
  • If needed, is there a caregiver (who is not at high risk of severe COVID-19 infection) who can provide support and help cover the patient’s basic needs?
  • Does the patient feel safe in their home?
    • Is there a history of family violence?
  • Who else lives in the house with the patient?
    • Are any household members at greater risk of contracting or of developing severe disease from COVID-19 (e.g. with consideration of age, presence of multiple risk factors, COVID-19 vaccination status, immunocompromised status)?
    • Is there space in the house for the patient to effectively isolate?
    • Is it safe for other household members to be in the household?
    • Do other household members understand the precautions they will need to take while the patient is isolating?
  • Does the patient understand the isolation requirements while they are at home?
  • Does the patient have care responsibilities, including caring for children, that might be affected by their diagnosis?
  • Will the patient be able to undertake telehealth consultations? Do they have access to a telephone, tablet, computer or other device that supports video consultations? Are they able to use the technology?
  • Will the patient be able to use technologies that may support care (ie pulse oximeter)?
  • Will the patient be able to self-monitor and communicate deterioration of symptoms?
    • Is the patient from a culturally and linguistically diverse (CALD) community?
    • If the patient is not fluent in English, do they or their caregiver know how to, and are they able to, contact their GP in the event of deteriorating symptoms, or contact 000 if emergency care is not required? Do they know how to use TIS?
    • Are there potential communication considerations for patients with hearing or visual impairment?
  • Is tertiary care support available for increased home surveillance requirements?
  • Where is the closest emergency medical care, if needed?
  • Where is the nearest COVID-19-equipped care environment?
  • Does the patient have access to private transport?