Home Health Care Services

Home health care services are provided to patients and families who need assistance with promoting, maintaining, or restoring a patient's health and level of independence and minimizing the consequences and effects of injury, disability, and illness. Home health care agencies are often referred to as hospitals without walls, since technological advances allow them to pack the items needed for care and bring them into a patient's place of residence. Home care services can be used as either a form of long-term care and service provision for chronically ill persons (thereby avoiding institutionalization) or as a form of short-term care for those who have been discharged from hospitals following acute illness or surgery.

home health care services

Services provided in the patient's home by traveling health care professionals.

hospitals without walls

Home health care agencies that bring care and medical technology to a patient's home.

These formal, regulated programs of care offer a wide range of medical, therapeutic, and also nonmedical services that are provided by a variety of health care professionals and also social workers and nonmedical volunteers in a patient's home (Jones, Harris-Kojetin, & Valverde, 2012) and are usually coordinated by a nurse case manager. This effectively allows many patients who in the recent past would have been hospitalized for continuing care to return home and have needed services brought directly to them as they convalesce (Jonas, 2003). Nursing services are the most frequently used home health service, and this care is often critical in easing the transition from hospital to home. The duration and frequency of home visits is dependent on the level of a patient's needs and the orders of the patient's physician (Barnett & Mayer, 1992). In addition to basic medical and personal care assistance services, home health care personnel maybe trained to perform specimen collection, radiographs, electrocardiograms, physical therapy, speech therapy, occupational therapy, mental health counseling, and social work services. In recent years home health agencies have begun employing nurse practitioners, enterostomal therapists, and clinical pharmacy consultants to provide more extended and sophisticated care. Advanced services such as intravenous therapies and ventilator support, which in the past were available only in an inpatient setting, may now take place in the comfort and familiar surroundings of the patient's home (Fiebach et al., 2007).

This sector of the health care industry enjoyed a great period of growth at the end of the twentieth century, as cost-effectiveness initiatives imposed by managed care organizations led many to explore home care services as a less costly alternative to inpatient nursing or hospital care. In many cases home care services can minimize the need for admission to acute care or long-term skilled nursing facilities. As of 2007, more than 1 million U.S. men and women aged sixty-five years and over were receiving home health care services each day. Currently over 20,000 home health care agencies exist in the United States, with over 80 percent of them operating on a for-profit basis and total expenditures on their services amounting to more than $34.5 billion per year (Jones et al., 2012).

Demographically, among individuals aged sixty-four to eighty-five, women had significantly higher rates of home care service utilization than

Rate of Receipt of Home Health Care per 1,000 Civilian Noninstitutionalized Population Aged Sixty-Five and over by Sex: United States, 2007

Figure 5.2 Rate of Receipt of Home Health Care per 1,000 Civilian Noninstitutionalized Population Aged Sixty-Five and over by Sex: United States, 2007

Note: § Statistically significant difference p < 0.05 by sex.

Source: Jones et al., 2012. Data from CDC, National Center for Health Statistic, National Home and Hospice Care Survey, 2007.

men (Figure 5.2). However, men over age sixty-five were more likely to receive skilled home health care services for wound care and physical therapy immediately after an inpatient stay, whereas women in that age group received homemaker services more frequently than men and were also found to require home health services for longer periods of time. Male patients over age sixty-five were found to be almost three times as likely as female patients of that age to have their spouse as their primary caregiver, whereas female patients in the same age group had a child or other nonspousal relative as their primary source of caregiving twice as often as the male patients did. Common services required by home health care patients aged sixty-five years and over include “skilled nursing services (84%), physical therapy (40%), assistance with activities of daily living (37%), homemaker services (17%), occupational therapy (14%), wound care (14%), and dietary counseling (14%)” (Jones et al., 2012).

Any patient or patient's family can purchase the services of a home health care agency, but most of the cost is typically covered by Medicare, Medicaid, or another third-party or managed care organization. Medicare remains the dominant payer for home care services, paying approximately 38 percent of the overall home health care expenditures annually (Sultz & Young, 2009). Ongoing cost-containment initiatives have led to stricter control of the amounts and types of services that are authorized for payment, and reimbursement for all services requires the approval of the patient's physician. Moreover, for this setting of care to be effective, consistent and thorough communication between the physician and the home health care workers is necessary (Fiebach et al., 2007). This care setting continues to be an integral part of the U.S. health care delivery system, providing an “effective, safe and humane alternative to institutional care for the medical treatment and personal care of individuals of all ages” (Sultz & Young, 2009, p. 303).

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