The History of Home Healthcare

For centuries, health care was done in people's homes. Midwives, medicine men and traveling doctors all performed their services in homes. Sometimes sick people went to a doctor's office, which was usually an extension of his home or a small clinic, but more often than not, the health care specialists visited the sick. Society moved away from home health care for several years in the early 1900s only to return to its benefits in the latter part of the 20th century.

Managing Infectious Diseases

• The most common health care need at the end of the 19th century was managing infectious disease and assisting with childbirth, as these were the leading causes of death at that time. Infectious diseases were a great fear, so those inflicted, along with their families, were quarantined to keep the disease from spreading to the rest of the population. Therefore, home health care was the most logical solution to the problem of disease. In addition, it made sense for the sick to stay put and for the healthy health care specialists to do the traveling. Also, the medical professionals did not have a lot of equipment to carry, so it was feasible for them to move from one house to the next to perform their services.

Rise of Organized Home Health Care

• Large organizations such as the American Red Cross and Metropolitan Life Insurance promoted home health care by offering such services to policy holders and establishing traveling nurse programs in rural areas. By 1909 there were as many as 566 home health care organizations scattered throughout the United States. In the early 20th century the kinds of health care services provided in people's homes continued to meet short-term needs such as treating infectious diseases and assisting with childbirth.

Efficiency Issues

• Eventually infectious diseases gave way to more chronic degenerative diseases. At the same time, advancement in technology, medical knowledge and treatments, and community development made it more feasible to perform health care practices at medical facilities. Health care professionals were using more and more medical equipment and prescribing more kinds of medicines, so it was much more practical and time efficient to keep all the tools in a central location such as a hospital rather than to carry it from house to house. In addition, it was considered more "modern" to receive health care in hospitals than at home.

The Cost Factor

• Even though the American economy was strong during the 1950s, hospital costs were rising rapidly making it more difficult for middle and lower class citizens to afford the health care they needed in hospitals. People voiced their concerns and nurses formed organizations to campaign for a return to home health care practices. The public debate became loud enough for the politicians to become involved, and in 1965 Congress passed the Medicare legislation to support health care costs, including home health care. American citizens moved into a new era in which they could choose the kind of health care they wanted to receive.

A Return to Home Health Care

• A hospice care movement began to sweep across the country in the late 20th century. Hospice care was studied, financial concerns explored, and legislation passed to include home health care benefits in Medicare. Such benefits were added to private medical policies as well. The Joint Commission on Accreditation of Hospitals developed hospice accreditation.

Home Health Care in the Modern Era

• Today home health care is available to people with terminal diseases who want to die at home; the disabled; and the chronically sick. Many elderly people choose to receive home health care because it is too difficult to get out of the house and maneuver through large hospitals and large crowds of people. Today's home health care addresses the needs of ongoing and long-term health needs as opposed to the short visits aimed to meet one specific need more than a century ago.