Customized Home Visiting Care Service Project for Vulnerable population

Background and issues: The Customized Home Visiting Care Service Project started to reduce the health inequalities in 2007. In particular, the low income person with multiple demands and population at risk such as the elderly, women, the disabled, and immigrant were targeted. Description: Indirect service such as education, counseling, consultation, networking, refer, and supporting as well as direct nursing service were provided through regular home visit in public health center. During Initiation period (in 2007-2008), project team developed the protocol. Almost 2,000 nurses in 253 public health centers were trained by government fund. Settlement period (from 2009 to 2011): The protocol was revised to meet target subject needs as result of process evaluation. More effective strategy such as multidisciplinary team, networking with community agency, advertisement, and building referral system adopted to manage their disease and change unhealthy lifestyle. Multidisciplinary team was composed and the case management was adopted. The central informative system built to monitor the home visiting care program. Lessons learned: For 5 years, the home care visiting service was settled successively. As the result of program evaluation, it was validated to be economically effective. It made a positive contribution to improving the health status of vulnerable populations and reducing medical expenses. However, some issues are still rose whether the program reduce the health equalities and what kind of strategies are effective within limited budget. Recommendations: This paper would recommend a serious of steps for development of the home visiting program for vulnerable population based on lessons learned.