Home care (also referred to as domiciliary care, social care, or in-home care) is supportive care provided in the home. Care may be provided by licensed healthcare professionals who provide medical treatment needs or by professional caregivers who provide daily assistance to ensure the activities of daily living (ADLs) are met. In-home medical care is often and more accurately referred to as home health care or formal care. Home health care is different non-medical care, custodial care, or private-duty care which refers to assistance and services provided by persons who are not nurses, doctors, or other licensed medical personnel. For patients recovering from surgery or illness, home care may include rehabilitative therapies. For terminally ill patients, home care may include hospice care.[1]
Home health services help adults, seniors, and pediatric clients who are recovering after a hospital or facility stay, or need additional support to remain safely at home and avoid unnecessary hospitalization. These Medicare-certified services may include short-term nursing, rehabilitative, therapeutic, and assistive home health care. This care is provided by registered nurses (RNs), licensed practical nurses (LPN's), physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), unlicensed assistive personnel (UAPs), home health aides (HHAs), home care agencies (HCAs) and medical social workers (MSWs) as a limited number of up to one hour visits, addressed primarily through the Medicare Home Health benefit. Paid individual providers can also provide health services through programs such as California's In-Home Supportive Services (IHSS),[2] or may be paid privately.
The largest segment of home care consists of licensed and unlicensed non-medical personnel, including caregivers[3] who assist the care seeker. Care assistants may help the individual with daily tasks such as bathing, cleaning the home, preparing meals, and offering the recipient support and companionship. Caregivers work to support the needs of individuals who require such assistance. These services help the client to stay at home versus living in a facility. Non-medical home care is paid for by the individual or family. The term "private-duty" refers to the private pay nature of these relationships. Home care (non-medical) has traditionally been privately funded as opposed to home health care which is task-based and government or insurance funded. California's In-Home Supportive Services (IHSS) also offers financial support for employing a non-medical caregiver.
These traditional differences in home care services are changing as the average age of the population has risen. Individuals typically desire to remain independent and use home care services to maintain their existing lifestyle. Government and Insurance providers are beginning to fund this level of care as an alternative to facility care. In-Home Care is often a lower cost solution to long-term care facilities.
Home care has also been increasingly performed in settings other than clients' homes, as home workers have begun assisting with travel and performing errands. While this has been increasingly performed for younger populations with disabilities, these changes may also reframe the concept of home care in the future.
Overview
"Home care", "home health care" and "in-home care" are phrases that have been used interchangeably in the United States to mean any type of care—skilled or otherwise—given to a person in their own home. Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care.
Non-medical in-home care is also called companion care or unskilled care. It is a valuable service for seniors in need of household help, social interaction, or transportation to appointments. Home care is most utilized by elderly people who live alone with impairments with their activities of daily living and have low social support. For those with adequate social and familial support, home care is delayed until the impairment level becomes severe or their caregiver is no longer able to support them independently. Home care services include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship.
Home health care is medical in nature and is provided by licensed, skilled healthcare professionals. Home health care providers deliver services in the client's own home. Professional home health services may include medical or psychological assessment, wound care, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy. Home care is often an integral component of the post-hospitalization recovery process, especially during the initial weeks after discharge when the patient still requires some level of regular physical assistance. Patients who received home health care after being discharged from the hospital are associated with decrease in use of the healthcare system, hospital readmission, and death.[4][5] These services may include some combination of professional health care services and life assistance services.
Activities of daily living (ADL) refers to activities, including bathing, dressing, transferring, using the toilet, eating, and walking, that reflect the patient's capacity for self-care.
Instrumental activities of daily living (IADL) refer to daily tasks, including light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone, and managing money, which enables the patient to live independently in the community.
While there are differences in terms used in describing aspects of home care or home health care in the United States and other areas of the world, for the most part the descriptions are very similar. However, it is important to note that there may be cultural differences in home care due to different familial structures - multigenerational households, multiple households, same-sex parents and single-parent families can compose networks of culturally diverse individuals who require home care. Decisions may be made by one dominant authority in the structure or through the collective community.
Estimates for the U.S. indicate that most home care is informal, with families and friends providing a substantial amount of care. For formal care, the health care professionals most often involved are nurses followed by physical therapists and home care aides. Other health care providers include respiratory and occupational therapists, medical social workers and mental health workers. Home health care is generally paid for by Medicaid, Medicare, long term insurance, or paid with the patient's own resources.
There is, however, a distinction made on a state-by-state basis according to how each state regulates the home care industry. In New York State, for example, "home health care" is used to describe medical services performed at home by a healthcare professional, whereas "home care" describes non-medical, private duty care. Other states do not make the same distinction, but the difference between the two must be accounted for when dealing with Medicare reimbursements. In most cases, when ordered by a physician, Medicare will pay for short-term medically necessary services provided in a home setting. A senior who requires only non-medical care, will NOT qualify for Medicare coverage of these services.
Home care aides, Certified Nursing Assistants (CNAs), and caregivers are trained to provide non-custodial or non-medical care, such as help with dressing, bathing, getting in and out of bed, and using the toilet. They may also prepare meals, accompany the client to medical visits, grocery shop, provide companionship and do various other errands.
Home health care software or home care software falls under the broad category of Health care Information Technology (HIT). HIT is "the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making"[6]
Aide worker qualifications
The state department of health issues requirement for that state. Workers can take an examination to become a state tested Certified Nursing Assistant (CNA). Other requirements in the U.S.A. often include a background check, drug testing, and general references.
Licensure and providers by state
California usually requires a state license for medical, non-medical and hospice agencies. All the HHAs operating in California are required to be licensed by the California Department of Public Health and are usually also certified by the Centers for Medicare and Medicaid Services. However, due to the recent demand in provider services in home care for elderly populations and populations with disabilities, there has been an increase in care by providers who are not licensed or certified who are associated with HCAs or private organizations.
Full-service agencies do pre-employment background checks, including (criminal), department of motor vehicle, and reference checks. Full-service agencies also train, monitor, and supervise the staff that provide care to clients in their home.
There is a certification available for home care companies in California, administered by the California Association for Health Services at Home.[7]
Florida is a licensure state which requires different levels of licensing depending upon the services provided. Companion assistance is provided by a home maker companion agency whereas nursing services and assistance with ADLs can be provided by a home health agency or nurse registry. The state licensing authority is the Florida Agency for Health Care Administration.[8]
Compensation
Compensation varies according to discipline, but the Bureau of Labor Statistics estimates that the 2021 median hourly wage for home health aides was $13.52 per hour.[9] There is a fair deal of variance in the compensation offered to Home health aides across different states. For example, Alaska had the highest annual wage of approximately $29,100 and West Virginia on the other end of the spectrum had the average salary of $18,020.[10]
Supreme Court case relating to fees
Since 1974 until 2015, home care work was classified as a "companionship service" and exempted from federal overtime and minimum wage rules under the Fair Labor Standards Act. The Supreme Court considered arguments on the companionship exemption in a case brought by a home care worker represented by counsel provided by Service Employees International Union. This 2003 case, Evelyn Coke v. Long Island Care at Home, Ltd. and Maryann Osborne, argued that agency-employed home caregivers should be covered under overtime and minimum wage regulations.
Evelyn Coke, a home care worker employed by a home care agency that was not paying her overtime, sued the agency in 2003, alleging that the regulation construing the "companionship services" exemption to apply to agency employees and exempt them from the federal minimum wage and overtime law is inconsistent with the law.[11] The Supreme Court heard the case in 2009.
In the court decision, the court stated the Fair Labor Standards Amendments of 1974 exempted from the minimum wage and maximum hours rules of the FSLA persons "employed in domestic service employment to provide companionship services for individuals ... unable to care for themselves." 29 U. S. C. §213(a)(15). The court found that the power of the Department of Labor (DOL) to administer a congressionally created program necessarily requires the making of rules to fill any 'gap' left, implicitly or explicitly, by Congress, and when that agency fills that gap reasonably, it is binding. In this case, one of the gaps was whether to include workers paid by third parties in the exemption and the DOL had done that. Since the DOL followed public notice procedure, and since there was a gap left in the legislation, the DOLs regulation stood and home health care workers were not covered by either minimum wage or overtime pay requirements (but see below).
Department of Labor rule
A rule issued from the DOL, entitled "Application of the Fair Labor Standards Act to Domestic Service," and meant to be effective from 1 January 2015, was written to revise "the definition of 'companionship services' to clarify and narrow the duties that fall within the term; in addition third party employers, such as home care agencies, will not be able to claim either of the exemptions [from federal overtime or minimum wage rules.] The major effect of this Final Rule [would be] that more domestic service workers will be protected by the FLSA's minimum wage, overtime, and record keeping provisions."[12] However, Home Care Associates of America, the International Franchise Association (IFA), and the National Association for Home Care & Hospice sued the DOL in regards to the rule, and a federal district court threw out the rule.[13] The Labor Department then appealed.[13] In August 2015, the rule was upheld by the United States Court of Appeals for the District of Columbia Circuit.[14]
Payment for home care
Medicare often is the primary billing source, if this is the primary carrier between two types of insurance (like between Medicare and Medicaid). Also, if a patient has Medicare and that patient has a "skilled need" requiring nursing visits, the patient's case is typically billed under Medicare.
Private insurance includes VA (Veterans Administration), some Railroad or Steelworkers health plans or other private insurance. "Self/family" indicates "private pay" status, when the patient or family pays 100% of all home care charges. Home care fees can be quite high; few patients & families can absorb these costs for a long period of time.[citation needed]
Types of services
Home care services are available to individuals who require intermittent or part-time skilled nursing care and/or rehabilitation therapies.[15] The typical services available under the designated term "home care" include nursing care, such as changing dressings, monitoring medications, providing basic daily activities like bathing, short term rehabilitation, occupational and speech therapy.[15] Some home health providers also include non-medical homemaker services including meal preparation, shopping, transportation, and some specific household chores.[15]
The types of services available for home care have expanded throughout the history of the United States health care system due to continuous modernization of medical technology, particularly in the 1980s.[15] Prior to the expansion, specialty services like intravenous antibiotics, oncology therapy, hemodialysis, parenteral and enteral nutrition and ventilator care, were only available in the hospital setting.[15] This newly available technology has proven cost effective and improves the quality of life, increasing independence and flexibility for patients.
Hospice care is a method of care that can be included in the home care realm, but is also available as in inpatient service. Hospice is a cluster of comprehensive services for the terminally ill with a medically determined life expectancy of 6 months or less.[15] Whether hospice services are performed at home or in a medical facility, the emphasis of care are the same; pain and symptom management, which is referred to as palliation.[15]
Pediatric home care offers assistance for young children born with low birth weight, chronic and long term conditions, acute physical conditions, mental health support, chemotherapy, and others.[16]
The available home care services are provided by a mix of physicians, registered nurses, licensed vocational nurses, physical therapists, social workers, speech language pathologists, occupational therapists, registered dietitians, home care aides, homemaker and chore workers, companions and volunteers.[15]
Research and program accreditation
In 2002, Lotus Shyu & Lee found that providing home nursing care is more suitable for patients rather than in-house nursing-home care for patients that are not seriously ill and who do not need the services after discharge from the hospital.[17] In another 2002 article, Modin and Furhoff regarded the roles of patients' doctors as more crucial than their nurses and care workers.[18] However, from an epidemiological standpoint, the risks of some community acquired infections are higher from home nursing than from inpatient nursing home care.[19] In regards to financial expenditure, home nursing care is more cost effective than inpatient nursing home care.[20] The quality aspect of home nursing was reviewed in a 2001 article in the Journal of Nursing Care Quality.[21] In 2011, Christensen & Grönvall published a study of the challenges and opportunities of providing communication technologies supporting the cooperation between home care workers and family members.[22] Although they provide home care for older adults in cooperation, family members and care workers harbour diverging attitudes and values towards their joint efforts. This situation is a challenge for the design of information and computer technology (ICT) for home care.[22]
1 2 3 4 5 6 7 8 Singh, Leiyu Shi, Douglas A.; Shi, Leiyu (2015). Delivering health care in America: a systems approach (Sixthed.). Jones & Bartlett Publishers. p.142. ISBN978-1-284-03775-3.{{cite book}}: CS1 maint: multiple names: authors list (link)
↑ Lotus Shyu, Yea-Ing; Hsiao-Chin Lee (2002). "Predictors of nursing home placement and home nursing services utilization by elderly patients after hospital discharge in Taiwan". Journal of Advanced Nursing. 38 (4): 398–406. doi:10.1046/j.1365-2648.2002.02193.x. PMID11985691.
↑ Lescure, François-Xavier; etal. (2006). "Community-Acquired Infection With Healthcare-Associated Methicillin-Resistant Staphylococcus aureus: The Role of Home Nursing Care". Infection Control and Hospital Epidemiology. 27 (11): 1213–1218. doi:10.1086/507920. PMID17080379. S2CID9477578.
↑ Paul IM, etal. (2004). "Cost-Effectiveness of Postnatal Home Nursing Visits for Prevention of Hospital Care for Jaundice and Dehydration". Pediatrics. 114 (4): 1015–1022. doi:10.1542/peds.2003-0766-L. PMID15466099. S2CID35728239.
↑ Riccio, Patricia A (2001). "Quality Evaluation of Home Nursing Care: Perceptions of Patients, Physicians, and Nurses". Journal of Nursing Care Quality. 15 (2): 58–67. doi:10.1097/00001786-200115020-00007.
1 2 Christensen, L.R.; Grönvall, E. (2011). "Challenges and Opportunities for Collaborative Technologies for Home Care Work". In S. Bødker; N. O. Bouvin; W. Letters; V. Wulf; L. Ciolfi (eds.). ECSCW 2011: Proceedings of the 12th European Conference on Computer Supported Cooperative Work, 24–28 September 2011, Aarhus, Denmark. London: Springer. pp.61–80. doi:10.1007/978-0-85729-913-0_4. ISBN978-0-85729-912-3.
Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Within the published literature, many definitions of palliative care exist. The World Health Organization (WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain, illnesses including other problems whether physical, psychosocial, and spiritual". In the past, palliative care was a disease specific approach, but today the WHO takes a broader patient-centered approach that suggests that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness. This shift was important because if a disease-oriented approach is followed, the needs and preferences of the patient are not fully met and aspects of care, such as pain, quality of life, and social support, as well as spiritual and emotional needs, fail to be addressed. Rather, a patient-centered model prioritizes relief of suffering and tailors care to increase the quality of life for terminally ill patients.
A nursing home is a facility for the residential care of older people, senior citizens, or disabled people. Nursing homes may also be referred to as care homes, skilled nursing facilities (SNF) or long-term care facilities. Often, these terms have slightly different meanings to indicate whether the institutions are public or private, and whether they provide mostly assisted living, or nursing care and emergency medical care. Nursing homes are used by people who do not need to be in a hospital, but cannot be cared for at home. The nursing home facility nurses have the responsibilities of caring for the patients' medical needs and also the responsibility of being in charge of other employees, depending on their ranks. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day.
Gentiva Health Services is a provider of home health care, hospice, and related health services in the United States. The company is headquartered in Atlanta, Georgia. Prior to its October 2014 acquisition by Kindred Healthcare, it was a Fortune 1000 company with over $1.7 billion in annual revenue and a member of the S&P 600 index.
Residential care refers to long-term care given to adults or children who stay in a residential setting rather than in their own home or family home.
Home health is a nursing specialty in which nurses provide multidimensional home care to patients of all ages. Home health care is a cost efficient way to deliver quality care in the convenience of the client's home. Home health nurses create care plans to achieve goals based on the client's diagnosis. These plans can include preventive, therapeutic, and rehabilitative actions. Home health nurses also supervise certified nursing assistants. The professional nursing organization for home health nurses is the Home Healthcare Nurses Association (HHNA). Home health care is intended for clients that are well enough to be discharged home, but still require skilled nursing personnel to assess, initiate and oversee nursing interventions.
Nursing credentials and certifications are the various credentials and certifications that a person must have to practice nursing legally. Nurses' postnominal letters reflect their credentials—that is, their achievements in nursing education, licensure, certification, and fellowship. The letters usually appear in the following order:
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers, including commercial healthcare insurers. The transition to the NPI was mandated as part of the Administrative Simplifications portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Private duty nursing is the care of clients by nurses, who may be licensed as RNs or LPNs/LVNs.
A health professional, healthcare professional, or healthcare worker is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician, physician assistant, registered dietitian, veterinarian, veterinary technician, optometrist, pharmacist, pharmacy technician, medical assistant, physical therapist, occupational therapist, dentist, midwife, psychologist, audiologist, or healthcare scientist, or who perform services in allied health professions. Experts in public health and community health are also health professionals.
Program of All-inclusive Care for the Elderly (PACE) are programs within the United States that provide comprehensive health services for individuals age 55 and over who are sufficiently frail to be categorized as "nursing home eligible" by their state's Medicaid program. The ultimate goal of PACE programs is to keep eligible older adults out of nursing homes and within their communities for as long as possible. Services include primary and specialty medical care, nursing, nutrition, social services, therapies, pharmaceuticals, day health center services, home care, health-related transportation, minor modification to the home to accommodate disabilities, and anything else the program determines is medically necessary to maximize a member's health. If you or a loved one are eligible for nursing home level care but prefer to continue living at home, a PACE program can provide expansive health care and social opportunities during the day while you retain the comfort and familiarity of your home outside of day hours.
A professional live-in caregiver provides personal care and assistance to individuals, including those suffering from chronic illness, Alzheimer's disease, and dementia, within the home setting. Typical duties of a live-in caregiver include meal planning and preparation, assistance with grooming, dressing and toileting, medication management, laundry and light housekeeping, and transportation/escorts to doctor's appointments or social engagements. Professional live-in caregivers are often provided by an outside agency, which may also coordinate their services with the client's preferred in-home health agency and other medical providers.
In health care and caregiving, a companion, sitter, or private duty is a job title for someone hired to work with one patient. Companions work in a variety of settings, including nursing homes, assisted living facilities, hospitals, and private homes, and their duties range from advanced medical care to simple companionship and observation. They may be qualified, for example as a nursing assistant.
In the United States, hospice care is a type and philosophy of end-of-life care which focuses on the palliation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual or social in nature. The concept of hospice as a place to treat the incurably ill has been evolving since the 11th century. Hospice care was introduced to the United States in the 1970s in response to the work of Cicely Saunders in the United Kingdom. This part of health care has expanded as people face a variety of issues with terminal illness. In the United States, it is distinguished by extensive use of volunteers and a greater emphasis on the patient's psychological needs in coming to terms with dying.
Hospice Savannah is a non-profit hospice based in Savannah, Georgia that was started in 1979. Hospice Savannah provides its services to an average of 200 terminally ill patients at a time in Chatham, Effingham, Bryan, Long, and Liberty counties. Being non-profit, Hospice Savannah is community-based and is a member agency of the United Way of the Coastal Empire. It is certified by Medicare and Medicaid and will provide its services to any patient regardless of any financial situations. It employs around 200 people and also receives support from its large volunteer group.
Unlicensed assistive personnel (UAP) are paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs). UAPs also provide bedside care—including basic nursing procedures—all under the supervision of a registered nurse, licensed practical nurse or other health care professional. UAPs must demonstrate their ability and competence before gaining any expanded responsibilities in a clinical setting. While providing this care, UAPs offer compassion and patience and are part of the patient's healthcare support system. Communication between UAPs and registered nurses (RNs) is key as they are working together in their patients' best interests. The scope of care UAPs are responsible for is delegated by RNs or other clinical licensed professionals.
The companionship exemption refers to federal labor regulations in the United States that exclude workers providing companionship services to the elderly or disabled from the federal minimum wage and overtime protections that apply to most other American workers.
Paraprofessional Healthcare Institute, Inc. (PHI) is a non-profit organization based in New York City that works to improve long-term services and supports for elders and individuals with disabilities, as well as improve the job quality of the direct-care workers who provide those services whether in people's homes or in nursing homes and other institutional facilities.
As of 2017, approximately 1.4 million Americans live in a nursing home, two-thirds of whom rely on Medicaid to pay for their care. Residential nursing facilities receive Medicaid federal funding and approvals through a state health department. These facilities may be overseen by various types of state agency.
VITAS® Healthcare is a provider of end-of-life care in the United States. Operating 50 hospice programs in 14 states and the District of Columbia, VITAS employs 10,000 professionals and serves an average daily census of more than 19,000 patients, according to the company's website.
A visiting nurse association (VNA), also known as a visiting nurse agency or home healthcare agency or association, is any of various American organizations that provide home healthcare and hospice services through a network of nurses, therapists, social workers, and other healthcare associates for patients who are housebound, recovering from an illness or injury, or are living with a disability or chronic condition.
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