this paper, I will discuss home care as the component of the U.S. health delivery system continuum. I will describe its role in providing health care services, as well as give the picture of its contribution to the overall healthcare resources management. I will also investigate the role of home care in transitioning patients from the hospital to the home. And finally, in the end, I will examine the present and future trends of home care development.
Home care or domiciliary is referred to as the supportive care that is carried out in the home of the patient by healthcare professionals, which is also called skilled care in the United States, or by friends or family also referred to as primary caregiver or voluntary caregivers that perform an informal type of care. Usually, the notion home care is involved in differentiating custodial care that is caring, which is provided by people who are not doctors, nurses, or other licensed medical staff, not taking into consideration the term home health care, considers care that is provided by authorized personnel.
Speaking of actually the concept of «home care» and «home health care» it is essential to mention that these phrases used interchangeably in the United States to describe any care provided to a person in their home. Both have been used in the past alternatively not taking into consideration of whether the person needs skilled care or not. Nowadays, there is an increasing movement to differentiate between «home health care» implying skilled nursing care and «home care» implying non-medical care (Chapman, 1994).
Home care has the goal to make it possible for people to stay at home rather than involve long-term, residential or institutional-based nursing care. Home Care providers render services in own home of the patient. These services may contain some combination of life assistance services and professional health care services.
Professional Home Health services can involve psychological or medical assessment, physical therapy, medication teaching, wound care, pain management, speech therapy, disease education and management, occupational therapy.
Life assistance services contain help with tasks on a day-to-day basis, such as food preparation, errands, medication reminders, transportation, housekeeping, laundry, shopping, and companionship.
Even though there are differences in notions utilized in describing aspects of Home Care or Home Health Care in the U.S. and other parts of the world, for the most part, the descriptions are almost the same.
Estimations for the United States reveal that most home care is informal with friends and family providing a necessary amount of attention. For regular care, the health care professionals usually involved are nurses followed by physical therapists and home care aides. Other providers of health care include occupational and respiratory therapists, mental health workers and medical social workers. Home health care is usually paid for by health insurance, public payers (Medicaid, Medicare), or spent with the patient’s finances.
While investigating into the home care, it is essential to understand that activities of daily living are said to be six activities, which include bathing, dressing, transferring, using the toilet room, eating, and walking, that show the patient’s capacity for self-care. The patient’s need for help with these activities for the Study conducted in the United States was measured by the note of support from agency staff at the time of the research. Assistance that a patient can get from people that are not personnel of the agency (for instance, friends, family members, or persons employed immediately by the patient and not by the company) was not enclosed in the study (Loar, 2007).
It is also essential to understand instrumental activities of daily living, which refers to six daily tasks discussed earlier- preparing meals, using the telephone, taking medications, light housework, shopping for groceries or clothes, and managing money, that provides the patient with the opportunity to live independently in the community. The patient’s necessity for help with such activities was measured in the research study by the note of assistance from agency staff. Speaking about aide personnel qualifications, it is not demanded that the person is supposed to have a GED or High School Diploma. Still, local Department of health for state requirements should be checked to find out details. Usually, aide personnel has experience in institutional care facilities before a home care agency. People can take a test to become a State tested Certified Nursing Assistant. Other requirements in the United States usually contain a check of the background, testing for drugs and general references.
In the United States, registered nurses involved in the home care field get in general around $22.00 to $30.00 per visit.
Payment of other skilled services can vary by the specific discipline.
Agencies’ rewards for non-medical home care are not reimbursed by Federal, State, or private insurance. Nevertheless, private long-term care insurance will usually cover policyholders for part of the price of non-medical home care, depending upon the policy terms (Loar, 2007).
In February 2004, the National Center for Health Statistics carried out the «National Home and Hospice Study» that was updated in 2005.
The information was gathered on about around 1.3 million people that receive home care in the United States. From mentioned amount, almost 30% were under 65 years old, when the majority, nearly 70%, was over 65 years of age.
The 2005 chart information of preliminary valuations based upon interviews with non-institutionalized citizens, nevertheless, reveals the comparatively stable amount of about 6 to 7 percent of adults age 65 that needed assistance for personal care – this has stayed about the same between 1997 and 2004 with data reliability of 95%. Those aged 85 or older were at least six times more likely to have a necessity in activities of daily living assistance than those of age 65. Speaking about payment disclosed in the study, 710,000 (of more then 1,3 million people) paid by Medicare – Medicare that is usually the primary billing source, if this is the primary carrier between two types of insurance (like between Medicaid and Medicare). Moreover, if a patient has Medicare and that client has a «skilled need» demanding nursing visits, the client’s case is billed under Medicare. Then, 277,000 paid by Medicaid – such amount seems rather low for Community Based Services or Home Care, particularly as a nationwide statistic. 235,000 people paid by private insurance, or self or family.
Private insurance contains Veterans Administration, some Steelworkers or Railroad health plans or other private insurance. Self or family point out the status of the private payment when the family or the client himself pays all home care expenses. Home care payments can be rather high; not many patients and families can handle such costs for a long period. 133,200 all other payments – include patients that are not able to pay, or those who had no care charge, or those whose payment source not yet defined or approved. Occasionally after case opening that is referred to as the formal paperwork process of patient admittance to home care services, there can be a small period when the office has not yet get confirmation by one of two or more insurances held by the patient. It is rather common. There can also be situations when the office has to make phone calls to ensure that a particular diagnosis covered by the primary insurance of the client. It is not unusual. These delays explain, partially, several circumstances when the source of payment would be listed as «unknown».
Future of providing home care services is tightly connected with the development of the technologies and information technologies that would allow to raise them to the upper level, as well as to improve their quality.
In conclusion, I would like to summarize that home healthcare assists seniors live independently for as long as it can be possible, given the restrictions of their medical condition. It covers a broad range of services and can usually delay the necessity for long-term nursing home care. More particularly, home health care can contain physical and occupational therapy, speech therapy, and even skilled nursing. It can include assisting the older adults with daily living activities such as bathing, dressing, and eating. Or it can consist of help with cooking, cleaning, other housekeeping duties, as well as following the daily regimen of prescription and over-the-counter medications. Here, it is essential to understand the disagreement between home health care and home care services. Even though they sound almost the same and home health care can involve some home care services, home health care is more oriented on medical support. When home care usually contains housecleaning and chore services, home health care typically includes helping seniors recover from an injury or illness. That is why the people that provide home health care are usually licensed practical nurses, or home health aides or therapists. The state permits most of the work for hospitals, home health agencies, or public health departments.
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