Home Health Care

Even in today’s struggling economy, one industry continues to grow by leaps and bounds: the home health care sector. Driven by an aging Baby Boomer population, the rising cost of health care, patients’ preference for in-home care versus hospitalization and the portability of equipment once used only in hospitals, the home health care industry offers an effective, convenient and for the most part cost-efficient alternative to traditional hospital care.

According to the U.S. government’s Bureau of Labor and Statistics, in 2006, the healthcare industry provided 14 million jobs. Of these jobs, 13.6 millions were wage and salary worker’s jobs and 438,000 jobs were for self-employed individuals. Health care is expected to generate an additional 3 millions wage and salary jobs from 2006 to 2016, making it the country’s largest sector-employer. The proportion represented by home health care givers is 6.9% or nearly a million employees, second only to hospital and nursing/residential facility employees.

With so many employees delivering services to an increasing number of patients in the privacy and comfort of their own homes, the home health care industry is burgeoning and setting standards for how our citizens receive their health care. Although you may never have used a home health care service, chances are high that you or a loved one will require home health care in the future meriting a closer look at what this health delivery system is all about.

What is it?

Home health care as referred to by the healthcare community is a formal, regulated program that delivers health care to individuals in their homes utilizing the skills of a variety of professionals. There are two types of home health care: short term and long term. The goal of short term home health care is rehabilitation. The goal of long-term care is to assist the chronically ill and the permanently disabled in achieving the highest possible level of physical and mental well-being and to provide support as they learn to live with and manage their illnesses or disabilities.

Even though this type of in-home care is a Medicare benefit—provided certain requirements are met—it is not necessary for a patient to have Medicare insurance to receive in-home services. However, the standard of care set by most home health agencies and the rules regulating the delivery of in-home services are generally based on the Medicare model. As standardized by the Medicare model, home health care services must:

• Be delivered under the care of a physician
• Be initiated by a detailed physician’s referral
• Be structured in a written, specific plan of care by the home care agency
• Be delivered to patients who are homebound
• Be given to patients who have a documented need for skilled nursing care or physical, occupational or speech therapy
• Be part time—28 hours or less per week or 8 hours or less per day
• Occur at least every 60 days unless an exception is granted in special cases

Home health care includes skilled nursing care services, skilled care services (physical, occupational therapy and speech-pathology therapy), medical social services and home health aide services for those receiving skilled care only.

To illustrate with a typical step-by-step example of how home health care is initiated, let’s use the case history of Mrs. Johnson. Mrs. Johnson, age 76, had a stroke from which she has recovered sufficiently to no longer benefit from acute or rehabilitation hospitalization. But, she continues to have left-sided weakness, particularly in her left hand and arm, as well as residual speech impairment. She lives by herself in an apartment on the second floor of an elderly housing complex. Several neighbors check on her from time to time and a friend who lives in her building has offered to do her weekly grocery shopping.

Before Mrs. Johnson is discharged, a medical social worker at the rehabilitation hospital where she has been hospitalized for 2 weeks will meet with the team that has been taking care of her—doctor, nurses, and physical, occupational and speech therapists. Mrs. Johnson’s physician wants her to receive home health care when she leaves the hospital to ensure that she continues to receive physical & speech therapy, Vitamin B12 injections monthly and an overall, medical assessment, including vital signs, every week. The medical social worker tells Mrs. Johnson’s physician that Mrs. Johnson will also need daily morning assistance with bathing, dressing and food preparation until her left arm becomes more functional. Mrs. Johnson’s physician gives the medical social worker an order for home health care that includes a detailed description of everything Mrs. Johnson will need from therapists to skilled nursing care to assistance from a home health aide. The medical social worker determines which home health care agency is suitable, contacts the agency, passes on the necessary information and sends the physician’s written order to the agency.

The home healthcare agency’s staff develops a written care plan for Mrs. Johnson which incorporates all the services ordered by her physician and schedules the dates and times of visits by therapists, nurses and home health aides. (Patients have a right to participate in formulating their own home health care plans and should not hesitate to speak to their agency representatives regarding their preferences such as the time of day that various visits will be convenient.) It is also the agency’s responsibility to periodically update Mrs. Johnson’s physician on her progress. If any changes to Mrs. Johnson’s care plan are indicated after she returns home, the doctor must order them before the agency can make modifications. When Mrs. Johnson is finally discharged from the rehab hospital to her home, all the home health care services she needs are in place and ready to go.

According to the U.S. Department of Health and Human Services, if you are the patient of a Medicare-approved home health agency, you have rights that must be in writing and given to you by the agency.

These rights are:

1. “The right to choose your home health agency, although for members of managed care plans, the choices will depend upon which home health agencies your plan works with.
2. The right to have your property treated with respect.
3. The right to have your family or guardian act for you if you are unable.
4. The right to complain to the agency or the State Survey Agency about your treatment or care if it is not provided, or staff shows disrespect for you or your property.
5. The right to be given a copy of your plan of care, so you can ask questions about the type of services and staff the home health agency plans to provide to you and how often you can expect those services.”

To locate a Medicare approved facility visit: www.medicare.gov and look at the information in the Home Health Compare section.

Who Needs It?

Patients who are expected to improve physically, like those recovering from surgery or a debilitating illness such as a stroke, benefit from receiving home health care-delivered rehabilitation services. Longer term home health care recipients such as those that are chronically ill or permanently disabled benefit from home health care services directed at helping them manage their illnesses and disabilities and services designed to prevent their further physical or mental deterioration. Patient services can be of a single type or any combination of the three types: skilled nursing, skilled care or home health aides.

Examples of skilled nursing care services are: wound care; instruction to patient and/or family caregiver on a relevant medical topic such as how to care for a diabetic patient receiving insulin; respiratory care involving oxygen or nebulizer administration; intravenous therapy; nutritional therapy such as tube feedings; injections; and monitoring such things as vital signs and patients with serious illnesses that are prone to instability. Examples of skilled care are: physical therapy, occupational therapy and speech/language therapy. Examples of home health aide services are: assistance with activities of daily living like dressing, ambulating, toileting, bathing and eating; light housekeeping, grocery shopping, laundry and meal preparation.

Benefits

It is comparatively less expensive than hospitalization. In-home health care is also a lifesaver for many patients and their families. Most patients find it comforting to be in familiar surroundings where they are near friends and family. For families spread afar, having their loved one on the receiving end of home health care professionals is reassuring. Updates and reports keep families and patients informed. In many cases, home care aides and other health professionals are often the only link for patients to the outside world, especially true of the elderly and disabled. Visiting nurses and aides become a kind of de facto family to homebound patients by providing much needed companionship.

Risks

The rapid growth of home health care services can be confusing. Varying regulations make it difficult to police personnel-and the agencies that hire them. Licensing of both training programs and graduates is often sporadic and in some cases nonexistent.

The Bottom Line

Home health care is a cost-effective alternative to long-term hospitalization, but keener oversight and more stringent regulation are needed to prevent fraud, to ensure licensing and to standardize criteria for agencies, training centers, personnel and in-home services. The definition as to what constitutes home health care is based on criteria set forth by Medicare, the general standard by which home heath care agencies abide. Home health care is ordered by a physician, put into motion by a health care agency and delivered by an agency’s paid health care personnel. Although home health care is a benefit covered under Medicare, a patient does not have to be on Medicare to qualify for home health care agency services. For Medicare patients to qualify for home-health-aide services like housekeeping or bathing, they must first be in need of skilled nursing care. Many health insurance companies provide coverage to policy holders for home health care. Deductibles and co-pays for these services vary from company to company. Home health care agencies are considered to be private contractors. They receive reimbursement from insurance companies or government agencies depending on the services rendered.

The information in the article is not intended to substitute for the medical expertise and advice of your healthcare provider. We encourage you to discuss any decisions about treatment or care with an appropriate healthcare provider.