About Home Health Care

Home health care has been around since the end of the 1800s in the U.S., but with skyrocketing health costs in hospitals, extended care, adult homes, hospices and nursing homes, it has become a growth industry. The good news is that home-based care includes more family participation than in any nonresidence setting. With new programs, the care can be directed by the consumer and overall financial and emotional cost to both the patient and care givers can be reduced. Less bureaucratic administration and more familiar surroundings for the patient are also pluses.

History

• In 1963, the National Association for Home Care and Hospice listed 1,100 home care providers. By 2002, the U.S. Census Bureau brought that number to 83,000 entities caring for nearly 8 million people. In spite of the Balanced Budget Act of 1997, which reduced Medicare reimbursements for home health care, the need for home health care, along with agencies and personnel to provide that care, continued to increase. Mary Paulsel of the University Center for Innovation and Entrepreneurship in Columbia, Missouri, wrote that while hospitals are running fewer home care programs, private businesses and nonprofits are taking up the slack. Even a sagging economy, labor and health care spokespeople like Gail Breen of Workforce Solutions in upstate New York said health care jobs remain stable.

Benefits

• Patients who can benefit from receiving care at home, rather than in a hospital or nursing home setting, include those with acute or chronic health problems, disabilities or terminal illness. Family members are encouraged to be part of the care team and a primary doctor or point-of-entry health care agency coordinates care to make sure services aren't duplicated or performed unnecessarily and that all needs of the patient are being met. Where consumer directed programs, like Visiting Nurses Home Care of Albany, New York, operate, consumers hire and supervise their own care. They must be Medicaid eligible to qualify for this program, however.

Types

• Home health care providers can be private for profit, nonprofit, public or municipal. Those receiving care can do so with private pay, private insurance or be Medicaid/Medicare recipients. The care received can be temporary, chronic or terminal in nature. While Medicaid/Medicare recipients can receive most of the types of home health care, some private pay insurance programs will not cover all aspects of home health care.

Warnings

• With health care workers coming into the home, care must be taken that background checks are performed, that universal precautions against infection are in place and no advantage is taken of the patient being cared for. Many of the duties of the personal care assistant have to do with taking care of tasks the patient can't do for themselves. Besides toileting, bathing, meal preparation, clothing and administering medications under the general supervision of a doctor and the specific supervision of the consumer, there may be housekeeping, shopping and errands performed. All is done to help keep the patient in her home for the highest quality of life possible.

Speculation

• The U. S. Census Bureau expects the ratio of one in eight American over the age of 65 in 1994 to increase to one in five more than 65 in 2030. As "baby boomers" age, the increase in all health care, including home health care, is expected to rise, according to the National Association for Home Care and Hospice.