At home health care
Home Care - health support at home
Care at home

The term ‘Home care’ is defined as a method of health care services that are provided specifically wherever a patient lives.  

Patients can receive home care services whether they live in their own homes, whether or not they live with family members, or live in an assisted living facility. The ultimate objective of home care is to provide for the medical needs of a patient while allowing them to remain living at home or residential setting, regardless of their age, condition or degree of disability. 

After a surgery or hospital stay, a patient may require certain home care services that can range from homemaking services which include cooking and cleaning up to access for skilled medical care. Some patients may require either home health aides or personal care attendants to help them with their activities of daily living (ADL’s).

home care delivery services

Delivering health care services to medical, dental, and nursing patients in their primary residence allows them to feel less anxious and more comfortable.  Therapists who make regular home care visits include speech-language pathology, physical therapy, and respiratory therapy, depending on each patient’s explicit needs.  General nursing care can be administered by both registered nurses as well as licensed practical nurses. In addition, nurses who specialize in areas including psychiatry, obstetrics, and cardiology may also be a part of the care equation. 

Semi-skilled home health aides provide what is considered to be custodial care in a patient’s residential settings.  Their duties are similar to those of nurses’ aides in clinics and hospitals.  These professionals who deliver in-home care to patients are employed often by independent for-profit home-care agencies, hospital agencies, or hospital departments.  Personal caregivers can also be hired directly by patients. However, it is more difficult to evaluate the specific background, references and credentials when they are not associated with a certified provider or heath care system. In addition, medical insurance may not cover the costs of a health care aide who does not come from a pre-approved source.

Home care nurses

Home care nurses are available to provide care for patients of every age, economic level, and extents of illness or disability. Many nurses are specialists in areas including hospice, mental health, or pediatric care. Home care nursing can also involve more than bio-medically based care. This depends on a patient’s specific religious or spiritual background.

Most patients are more comfortable convalescing in their own homes, in contrast to an inpatient stay in a hospital or clinic. However, the home is not always the best place for medical care giving.  Depending on the patient’s living situation and their relationships with the others residents, home care for many is the first-best option. In addition, use of home care continues to grow in popularity. Since hospital stays have shortened considerably since the 1980s, the advent of the diagnosis-related group (DRG) reimbursement system has become an important part of a continuing effort to reduce health care costs.

Home Care Drawback

 One drawback is that many patients may come home “quicker and sicker,” with the need of some level of care services and support that family or friends are not qualified to offer. With expansion of Community based health care, patients have increased options for care services from home.

The first documented form of home care services was during the late seventeenth century when members of Roman Catholic religious orders in Europe first delivered home care services along with pastoral visits. Presently, there are many faith-based home care agencies and Visiting Nurse Associations (VNA’s) that continue this tradition of delivering a cross section of home care services to meet the individual needs of patients throughout North America.

Home Care History

Through the 1950’s, home care was a seen as a community-based delivery model  that provided care options to patients regardless of their ability to pay. These agencies relied on donations from individuals or charitable organizations, as well as limited funding from various government agencies.  In the 1960’s the life expectancy of the United States population began to increase with advances in medical science. As a bi-product, an increasing number of both elderly and disabled people required access to health care in their homes as well as in institutions.  The federal government enacted the Medicare and Medicaid programs in 1965 to fund these services and regulate the health care available to them. 

Government involvement resulted in regulations that changed the focus of home care from a nursing care delivery service to care delivery under the direction of a physician. Home care delivery is paid for either by the government through Medicare and/or Medicaid; by private insurance or health maintenance organizations (HMOs); by patients themselves; or by certain non-profit community, charitable disease advocacy organizations (e.g., ACS), or faith-based organizations.

Home care delivery services which are provided by Medicare-certified agencies are tightly regulated. For example, a patient must be determined to be homebound in order to receive Medicare reimbursed home care services. The homebound requirement—one of many criteria—means that the patient must be physically unable to leave home (other than for infrequent trips to the doctor or hospital), thereby restricting the number of persons eligible for home care services. Private insurance companies and HMOs also have certain criteria for the number of visits that will be covered for specific conditions and services. Restrictions on the payment source, the physician’s orders, and the patient’s specific needs determine the length and scope of services.

Since home care nursing services are provided on a part-time basis; patients, family members, or other caregivers are encouraged and taught to do as much of the care as possible. This approach goes beyond payment boundaries; it extends to the amount of responsibility the patient and his or her family or caregivers are willing or able to assume in order to reach wellness outcomes. Nurses who have received special training as case managers visit the patient’s home and draw up a plan of care based on assessing the patient, listing the diagnoses, planning the care delivery, implementing specific interventions, and evaluating outcomes of the implementation phase. Planning the care delivery includes assessing the care resources within the circle of the patient’s caregivers.

At the time of the initial assessment, the visiting nurse, who is working under a physician’s orders, enlists professionals in other disciplines who might be involved in achieving expected outcomes, whether those outcomes include helping the patient return to a certain level of health and independence or maintaining the existing level of health and mobility. The nurse provides instruction to the patient and caregiver(s) regarding the patient’s particular disease(s) or condition(s) in order to help the patient achieve an agreed-upon level of independence. Home care nurses are committed to helping patients make good decisions about their care by providing them with reliable information about their conditions.

Conclusion

 Since home care relies heavily on a holistic approach, care delivery includes teaching coping mechanisms and promoting a positive attitude to motivate patients to help themselves to the extent that they are able. Unless the patient is paying for home care services out-of-pocket and has unlimited resources or a specific private long-term care insurance policy, home care services are scheduled to end at some point. Therefore, the goal of most home care delivery is to move both the patient and the caregivers toward becoming as independent as possible during that time.

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