Home care in the United States

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. Often, the term home health care is used to distinguish it from 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 terminally ill patients, home care may include hospice care. For patients recovering from surgery or illness, home care may include rehabilitative therapies.[1]

Outpatient elder care

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) and medical social workers (MSWs) as a limited number of up to one hour visits, addressed primarily through the Medicare Home Health benefit.

The largest segment of home care consists of licensed and unlicensed non-medical personnel, including caregivers[2] 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.

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.

Types of services

Home care services are available to individuals who require intermittent or part-time skilled nursing care and/or rehabilitation therapies.[12] 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.[12] Some home health providers also include non-medical homemaker services including meal preparation, shopping, transportation, and some specific household chores.[12]

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.[12] 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.[12] 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.[12] 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.[12]

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.[12]

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.[13] In another 2002 article, Modin and Furhoff regarded the roles of patients' doctors as more crucial than their nurses and care workers.[14] However, from an epidemiological standpoint, the risks of some community acquired infections are higher from home nursing than from inpatient nursing home care.[15] In regards to financial expenditure, home nursing care is more cost effective than inpatient nursing home care.[16] The quality aspect of home nursing was reviewed in a 2001 article in the Journal of Nursing Care Quality.[17] 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.[18] 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 state of affairs is a challenge for the design of ICT for home care.[18]

See also

  • Carers' rights
  • Caring for people with dementia
  • Early postnatal hospital discharge
  • Elderly care
  • Home care in the United Kingdom
  • Nursing home care
  • Transgenerational design
  • Unlicensed assistive personnel

Notes

  1. "Definition of caring for elderly". LiveStrong.com. Retrieved 15 June 2012.
  2. "Caregiver". The Free Dictionary By Farlex. Retrieved 15 June 2012.
  3. Brailer, T; Thompson, D (2004). "Health IT strategic framework". Department of Health and Human Services.
  4. "CAHSAH". Retrieved 15 May 2014.
  5. "AHCA". Fdhc.state.fl.us. Archived from the original on 12 July 2017. Retrieved 10 March 2012.
  6. "Occupational Employment and Wages, May 2012" Retrieved 19 July 2013
  7. "Home Health Aide Online". Home Health Aide Online.
  8. Martin, Douglas (10 August 2009). "Evelyn Coke, Home Care Aide Who Fought Pay Rule, Is Dead at 74 (New York Times Aug.9, 2009)". The New York Times. Retrieved 10 March 2012.
  9. "Application of the Fair Labor Standards Act to Domestic Service" (PDF). Retrieved 20 November 2013.
  10. "Judges weigh minimum wage, overtime rules for home care providers". TheHill. Retrieved 11 May 2015.
  11. Schencker, Lisa. "Court upholds rule requiring higher wages for home healthcare workers". Modern Healthcare. Retrieved 22 August 2015.
  12. Singh, Leiyu Shi, Douglas A.; Shi, Leiyu (2015). Delivering health care in America: a systems approach (Sixth edition. ed.). p. 142. ISBN 978-1-284-03775-3.
  13. 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. PMID 11985691.
  14. Modin, S.; A. K. Furhoff (2002). "Care by general practitioners and district nurses of patients receiving home nursing: a study from suburban Stockholm". Scandinavian Journal of Primary Health Care. 20 (4): 208–212(5). doi:10.1080/028134302321004854.
  15. Lescure, François-Xavier; et al. (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. PMID 17080379.
  16. Paul IM, et al. (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. PMID 15466099.
  17. 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.
  18. Christensen, L.R.; E. Grönvall (2011). "Challenges and Opportunities for Collaborative Technologies for Home Care Work". S. Bødker, N. O. Bouvin, W. Lutters, V. Wulf and L. Ciolfi (eds.) ECSCW 2011: Proceedings of the 12th European Conference on Computer Supported Cooperative Work, 24–28 September 2011, Aarhus, Denmark. Springer: 61–80. doi:10.1007/978-0-85729-913-0_4.
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