Home Care Health Article

Definition

Home care is a form of health care service provided wherever a patient lives. Patients can receive home care services whether they live in their own homes with family members or in an assisted living facility. The purpose of home care is to promote, maintain, or restore a patient's health and reduce the effects of diseases or disabilities.

Description

The goal of home care is the provision of whatever a patient needs in order to remain living in his or her home, regardless of age or disability. The services provided may range from such homemaking services as cooking or cleaning to skilled medical care for patients on ventilators or dialysis machines or those receiving infusion therapies. Some patients require home-health aides or personal care attendants to help them with activities of daily living (ADL).

Medical, dental, and nursing care may all be delivered in the patient's home, which allows him or her to feel more comfortable and less anxious. Therapists from speech-language pathology, physical therapy, and respiratory therapy departments often make regular home visits, depending on the patient's specific needs. General nursing care is provided by both registered and licensed practical nurses; however, there are also nurses who are clinical specialists in psychiatry, obstetrics, and cardiology who provide care in these areas when prescribed. Home-health aides provide what is called custodial care in domestic settings; their duties are similar to those of nurses' aides in the hospital. Professionals who deliver care to patients in their homes are employed either by independent for-profit home-care agencies or by hospital agencies or departments. Personal care attendants can also be hired privately by patients; however, not only is it more difficult to evaluate an employee's specific background and credentials when he or she is not associated with a certified agency or hospital, but medical insurance may not cover the expense of an employee who does not come from an approved source.

Viewpoints

Often, patients are more comfortable in their own homes, rather than a hospital settings. Depending on the patient's living status and relationships with others in the home, however, the home is not always the best place for caregiving. Nevertheless, home care continues to grow in popularity. Hospital stays have been shortened considerably, starting in the 1980s with the advent of the diagnosis-related group (DRG) reimbursement system as part of a continuing effort to reduce healthcare costs. But as a result, many patients come home "quicker and sicker," and in need of some form of care or help that family or friends may not be able to offer. Community-based healthcare services are expanding, giving patients more options for assistance at home.

History

It is helpful to have some basic information about the evolution of home care in order to understand the public's demand for quality health care, cost containment, and the benefits of advances in both medical and communication technologies. The first home care was delivered by members of Roman Catholic religious orders in Europe in the late seventeenth century. This form of care giving was later performed by registered nurses who "visited" people in their homes. Visiting Nurse Associations (VNAs) were formed toward the close of the nineteenth century. Today there are many home-care agencies and VNAs that continue to deliver a wide range of home-care services to meet the specific needs of patients throughout the United States and Canada.

Social factors have historically influenced home-care delivery and continue to do so today. Before the 1960s, home care was a community-based delivery system that provided care to patients whether they could pay for the services or not. Agencies relied on charitable contributions from private citizens or charitable organizations, as well as some limited government funding. But as the life expectancy of the United States population began to rise, advances in medical science saved patients who might have died in years past. As a result, more and more elderly or disabled people required medical care in their homes as well as in institutions. Consequently, the federal government put Medicare and Medicaid into place (1965) to help fund and regulate health-care delivery for this population.