Home health care provides medical services to individuals who are unable to support the activities of daily living by themselves. Delivered by a licensed medical personnel (e.g. registered nurse, physical therapist, occupational therapist, speech language pathologist, home health aide, and medical social worker), home health care enables adults and seniors to recover and remain in the comfort of their homes. Costly hospitalizations or facility stays are avoided. Home health care can be paid for by the patient, or through public (Medicare, Medicaid, Older Americans Act, Veterans’ Administration) or private insurance plans. A majority of home health care services is devoted towards senior care. However, the scope of home health care encompasses all ages of patient population.
Historical overview: A trip down the annals of history shows that home health care was the norm since the earliest of times. However, by 1930s, all acute care in the United States was provided for in hospitals. Visiting nurses were available for in-home care of chronically ill patients. As medical technology advanced over the years, it became more convenient to provide medical services in dedicated facilities and hospitals. By the 1980s, however, there was an increase of referrals to home care nurses, in order to facilitate prompt hospital discharge and support post-acute recovery. The Medicare Act of 1965, for the first time, provided funding to home health care agencies. Medicare home health care services continued to expand through the Omnibus Reconciliation Act of 1986. By 1997, there were 10,444 Medicare certified home health agencies in the US. The Balanced Budget Act of 1997 was implemented to place stricter eligibility criteria for Medicare home health care. These changes led to a significant fall in Medicare home health care, which was 4% of all Medicare spending by 1999, as compared with 9% between 1990 and 1997.The Prospective Payment System (PPS) and Outcome and Assessment Information Set (OASIS) were created in 2000 to help recover Medicare home health care.
Current Standing: According to Medicare Payment Advisory Commission (MedPAC), in 2011, 3.4 million Medicare beneficiaries received home care, making up for $18.4 billion of Medicare spending; the number of home health care agencies participating in Medicare was 12,199. In the US today, approximately 7.6 million people require home health care, and there exists over 20,000 home health care agencies.
Opportunities: Home health care agencies today are facing the hefty task of serving 78 million baby boomers in the US. According to the U.S. Bureau of Labor Statistics, home health care will be the most sought profession in the next decade. Therefore, this sector of healthcare holds great growth potential in the coming years.
Compared with costly hospitalizations, home health care is a clinically-advanced and cost-effective alternative that is often preferred by patients. Along this line, Teresa Lee, Executive Director of the Alliance for Home Health Quality and Innovation (AHHQI), points out, “Home healthcare can play a leading role in producing greater efficiency in care delivery and reducing overall healthcare spending.”
Over a five-year average, the cost of home health services has risen 1.3%, which is a third of the rate of increase in other sectors. This demonstrates how valuable the home health care sector has been in aiding US economic recovery. The U.S. Bureau of Labor Statistics reported in July 2013 that the home health care sector created 3,900 new jobs in the previous month, topping the charts among other healthcare fields.
Challenges: The U.S. Department of Labor has projected that home health is one of the fastest growing industry, expected to add well over 1 million new jobs throughout the next decade. However, the low compensation of home health care workers is a significant limitation. Furthermore, the complex billing involved for Medicaid and Medicare reimbursement leads to staffing challenges. Finally, the home health care industry has the additional responsibility of maintaining standardized qualification and training across the states. All this has resulted in high employee turnover in the past.
Conclusion: Home health care is a low cost, efficient and fast growing sector, which is forecasted to create 1 million new US jobs in the near future. The implementation of the latest information technology and efficient chronic care management systems along with a skilled workforce will enable home health care agencies to best serve the disabled and frail.