ABOUT HOME CARE

Home care in the United States is a vital part of health care delivery, having provided high-quality health care in the home setting for more than a century. More than 20,000 providers deliver home care services to some eight million individuals who require services because of acute illness, long-term health conditions, permanent disability, or terminal illness.

The first home care agencies were established in the 1880s. Their number grew to some 1,100 by 1963 and to more than 20,000 currently. A primary reason for the tremendous growth and popularity of home care was the Medicare enactment in 1965. At this time Medicare made home care services, primarily skilled nursing and therapy, available to the elderly. In 1973, these services were extended to certain disabled younger Americans. Between 1967 and 1985, the number of agencies certified to participate in the Medicare program grew by more than three-fold, from 1,753 to 5,983.

In the mid-1980s, the number of Medicare-certified home care agencies leveled off at around 5,900 as a result of increasing Medicare paperwork and unreliable payment policies. These problems led to a lawsuit brought against the Health Care Financing Administration (HCFA) in 1987. The successful conclusion of this lawsuit resulted in rewriting the Medicare home care payment policies. Since these revisions, Medicare's annual home care benefit increased significantly and the number of home care agencies had risen to over 10,000. More recently, the number of Medicare-certified home health agencies declined significantly with some estimations recording over 3000 home care closures since 1997 when Medicare home health reimbursement enacted the Balanced Budget Act of 1997.

Medicare added hospice benefits in October 1983, 10 years after the first hospice was established in the United States. Hospices provide palliative medical care and supportive social, emotional, and spiritual services to the terminally ill and their families.

Non-certified home care agencies home care aide organizations, and hospices that remain outside Medicare do so for a variety of reasons. Some do not provide the kinds of service that Medicare covers. For example, home care aide organizations that do not provide skilled nursing care are not eligible to participate in Medicare.

Medicaid payments for home care are divided into three main categories, traditional home health benefit that is a mandatory service provided by all states and two optional programs, the personal care option and home and community-based waivers. Together, these three home health services represent a relatively small but growing portion of total Medicaid payments. Hospice is an optional Medicaid service that is currently offered by 42 states.

Formal home care workers (caregivers) are professionals and paraprofessionals who provide in home health care and personal care services, and are compensated for the services they provide. However, some estimates indicate that almost three-quarters of elderly persons with severe disabilities receiving home care services rely solely on family members or other unpaid help such as church volunteers.

Home care is a cost-effective service, not only for individuals recuperating from a hospital stay but also for those who, because of a functional or cognitive disability, are unable to take care of themselves. However, best argument for home care is that it is a humane and compassionate way to deliver health care, allowing the patient and their family to maintains dignity and independence. Additionally, home care allows patients to take an active role in their care, becoming members of a multidisciplinary health care team.