Home Health Care

Home health care is the term used to refer to health care that is given to patients for treatment of certain illnesses or injuries in the comfort of their own homes by licensed healthcare professionals. The primary purpose of home health care is to allow patients to stay at home while receiving professional medical attention, instead of going to medical institutions such as hospices, clinics, or hospitals. Licensed health care providers (e.g., caregivers, therapists, nurses, doctors) render their services in the patient’s own home.

Home Health Care Services

Home health care services may include the following professional services:

• regular medical evaluation
• nursing
• pain management
• personal hygiene, grooming, wound care and other medically prescribed assisyance
• disease education
• hospice care
• physical, speech, or occupational therapy

Home health care providers also render life assistance services such as tasks including the six activities of daily living:

• eating
• dressing
• transferring
• bathing
• using the toilet
• walking

Professional and licensed health care providers also help their patients learn to live independent and sufficient again and go back to their respective communities by assisting them in the following activities:

• meal preparation
• taking medicines
• housework
• shopping for food, groceries, clothes and other household items
• using public services such as telephones
• managing money

In the past, the term ‘home health care’ has been has been loosely interchanged with ‘home care’, but recent movements aimed towards defining the two terms separately and use them correctly. Home health care - skilled, nursing care provided by licensed caregivers, is distinguished from home care that refers to informal non-medical care, given to patients mostly by family members, friends and other people who are not doctors, nurses, or licensed caregivers. It is comfortable to say that home health care is more medically oriented than home care alone. Other home health care personnel include registered nurses, therapists, homecare aides and companion/homemakers.

History of Home Health Care

The history of home health care is not a difficult path to track. The early part of 19th century saw the beginnings of basic home care when qualified nurses visited the homes of the poor and sick to take care of them. At this time, nurses worked at home and their most basic duties included helping new mothers and treat patients inflicted with infectious diseases. After some time, the demand for nurses who can provide professional medical help at home increased. Charitable institutions who noticed the trend began to sponsor these visiting nurses, and in 1909, 1,413 licensed nurses worked for more than 500 organizations supporting the poor and the sick. In the same year, an insurance provider, Metropolitan Life Insurance Company, decided to offer the services of visiting nurses to their policy holders, and this gave birth to the world’s first organized home health care system.

Red Cross followed Metropolitan Life by starting a visiting nurse program aimed to provide medical services to people in the rural areas. Red Cross was also able to persuade its local chapters to organize a similar scheme and this practice spread fast across the United States.

However, towards 1930, the trend began to change as infectious diseases were replaced by chronic degenerative diseases as the leading cause of death among Americans. People preferred to seek hospital care than home care, and by the middle of the 20th century, home care was almost non-existent. But the 50s saw a different trend as hospital care became costly. Home care became a preference again among people from all walks of life.
The significant years in the history of home health care include:

• 1965 – Medicare was ratified aiming to grant benefits to home care patients. Medicaid, the state’s medical assistance program followed, giving the poor provisions for home health care.
• 1982 – The National Home Care Association was established to provide quality health services to patients at home and in hospices.

Home Health Care Facts and Trends

Home health care services in the U.S. have become an integral part of the country’s healthcare system. From the visiting nurses in the early 19th century, the promising home health care industry today comprises a variety of agencies and associations offering wide range of services. Hospices, home health agencies, and home care aid institutions compose a large part of the industry.
In 2007, the U.S. Department of Health and Human Services, through the publication ‘Trends in Health and Aging’ revealed the current status of home health care use among older women living in the U.S. Though the study also included elderly males, it was more focused on women as they compose majority of the older population. The study revealed the following facts about older women in the U.S.:

• Older women needed more home health care services than older men. Women aged 65 and over have higher expenses for home health care services than men of the same age.
• In 2000, the discharge rate for any home health care service was 1,521 per 10,000 women aged 65 and over compared with 1,230 per 10,000 for men.
• Because women tend to live longer than men, they get through more limitations as they grow older. The study concluded that more older women than men heavily depended on informal home caregivers, and has a higher reliance on home health care or nursing home care.

Following are more home health care facts and trends:

• In 2009, more than 20,000 home health care organizations across the U.S. provide services to about 8 million people who are acutely or terminally ill, have continuing medical condition, or permanently disabled. These organizations make annual revenue of $55 billion.
• Medicare and Medicaid are the highest paying agencies for home health care services. In 1996, there are more than 9,000 agencies participating in the Medicare program.
• Health care services availed by patients at home include: skilled nursing, personal care, physical therapy, speech therapy, occupational therapy, counseling, housekeeping and companionship, and drug administration.
• Seventy percent of people who avail of home health care services are 65 years or older, and their most common medical conditions are diabetes and cardio-vascular related illnesses. The remaining 30 percent are below 60 years, and need assistance for rehabilitation, disabled, or have more than one chronic medical condition.
• In the past decade, more Americans spent half the time less in hospitals following any surgery, and preferred home health care instead.

Home Health Care for the Elderly

Caring for the elderly, also referred to as long-term care, is health care service given for an extended amount of time to patients who need assistance in doing normal daily activities because of cognitive impairment or severe loss of muscular control and strength. Home health services for the elderly may include all activities needed to satisfy the special requirements of senior citizens such as assisted living, adult day care, therapies (physical, speech, occupational), professional nursing care, counseling, social services and a wide array of supportive personal care that is sometimes provided by the patient’s family members, if not by skilled health caregivers. At some extent, long-term care may also include training the elderly to help them adjust to and overcome the physical and psychological limitations that go with aging. Home health care helps older people live independently despite the limitations of their medical condition. Its services can often delay the need of older people for long-term nursing home care.

In the U.S. and anywhere in the world, the family is the most important care provider for the elderly. Majority of the primary home care providers in the U.S. are the patients’ family members. According to Family Caregiver Alliance, home care providers are mostly women, and estimates showed that the percentage of family caregivers who are women range from 59-75%. This causes great wage losses due to caregiving, and leads most families with older members to avail of professional home health care services.
As a procedure, a physician’s approval is needed to avail of a professional caregiver in the U.S. The physician must declare and certify the need for a professional caregiver. Once approved, home health caregivers can be hired from a wide number of agencies and companies offering the service.

Among the home health care services available for the elderly, adult daycare has been proven to be effective in helping the older patients and their families. Adult daycare includes home health care programs intended to give medical care and companionship to the sick and disabled requiring more assistance and strict supervision throughout the day. Because of adult daycare programs, the patients’ family members have freedom to work and perform their daily activities without worrying about their elderly relative’s safety and care.
Another home health care service for the elderly that is being widely practiced is called in-home respite care, which involves services given to more impaired elderly patients. The following services are provided by in-home respite care:

• Companion services – this service helps the caregiver supervise, entertain, or counsel the older person when he/she is lonely and in need of some company.
• Homemaking services – a home health care service provider assists the patient with housekeeping, meal preparation, or shopping for food items and medicines.
• Personal care services – this is to help the elderly take a bath, dress, go the bathroom, or even walk around the house.
• Skilled care services – this service aims to assist the primary caregiver in looking after the elderly’s medical requirements, such as medications and therapies.

Most seniors prefer to stay at their homes and receive home health care than move to nursing homes or hospices. Staying at home with their children and other family members mean a lot to older people, as familiar surroundings help them heal. But illnesses and certain disabilities can pose a great deal of challenge for both the elderly and their family members. Fortunately, skilled and professional home health care is easily accessible now, and is a good option for the elderly and their families.

The Cost of Home Health Care

Professional home health care is a great help to any patient and his/her family. Caregivers can be hired through various agencies, but may be costly. Privately-hired caregivers may be less costly, but pose additional risks.
In the U.S., medical (skilled nursing care) and non-medical (social care) care are distinguished from each other as insurance and public medical funding strictly limits coverage to the former. Eighty-six percent of more than one million Americans in assisted living facilities pay for health care using their personal money.  Others seek financial assistance from family, friends, or state agencies. This is so because Medicare does not include home care expenses unless there is a need for skilled medical nursing care, or the service is rendered inside nursing facilities. Medicare, however, pays for some professional home health care when the elderly meet the requirements set by the Medicare home care health benefits.

• In the U.S., privately-hired home health care providers are paid an hourly rate of $8-$15, depending on the state. If the health care provider is hired through an agency, the hourly rates are 40%-70% higher.
• Stay-in home health care providers are paid between $120-$200 daily.
• Registered nurses employed as home health care providers in the U.S. are paid $22-$30 per visit. Some charge as high as $45-$55, and are entitled to receive $0.52-$0.58 per mile, tax-free.
• Direct-hired caregivers are paid an hourly rate between $8-$15, depending on the patient’s location, the number of hours rendered by the caregiver, and the his/her health care experience.

The Future of Home Health Care

Home health care has come a long way from the visiting nurses of the 19th century. Today in the 21st century, Americans are more educated and have a higher degree of awareness about the most up-to-date health trends and topics, and live longer. Experts and studies predict that home health care will further expand in the years to come. By 2030, 20% of the U.S. population will be composed of people aged 65 and over. This segment of society will place a great impact on the country’s health and social security system. As the ratio of taxes payers against those benefitting from institutional medical care decrease, home health care emerges to be the most cost-effective alternative to expensive hospital care.