Home is Where the Heart is.

As health care reform comes to pass, there is a building momentum towards keeping patients in their homes whenever possible. Home care is fast becoming an integral part of the care continuum, bridging the clinic-based care model and the actual world patients live in.

For All Ages and Many Conditions

The primary population creating a demand for home care is seniors. As 78 million Baby Boomers approach retirement age, U.S. demographics are shifting significantly. Seniors 65 and older will soon constitute 20 percent of the population. And it’s estimated that by the year 2020, 12 million older Americans will need long-term care.

In addition to the senior niche, home care serves people of all ages who are recovering from health challenges, disabled, chronically ill or in need of end-of-life care. Their ongoing needs may be medical, nursing, therapeutic or just assistance with the basic activities of daily living. Home care ranges from a one-hour weekly visit to 24-hour care.

Chronic patient needs that are being handled by home care nurses include tracheotomy, ventilator, g-tube, IV therapies and many cardiac issues. Cancer and transplant patients are also recuperating at home. Skilled private-duty nurses and case managers working in the home regularly meet complex medical needs. All such nurse activities are signed off by MDs, and patient care plans are re-certified at a minimum every 60 days.

Additional technologies that improve home care service levels include telehealth service management, electronic medical records and a variety of assistive technologies such as home sensors. A nurse using telehealth equipment, for instance, can potentially make up to 15 visits a day rather than the standard five.

Types of Home Care

Home care is anywhere from 5-20 times less expensive than facility care. It also provides a one-on-one focus, which is difficult to obtain in hospitals or group facilities. There are four basic home care service options:

1. Personal care assistants provide assistance with activities of daily living such as dressing, bathing, feeding, getting to doctor appointments, etc. and are not licensed by the state. This type of care is typically paid for by Medical Assistance.

2. Private duty care – basically private pay care – provides assistance with non-medical needs such as shopping, cooking, transportation and companionship and involves household management services but no hands-on medical care. Some long-term care policies will cover such home care, but reimbursement terms and exclusion criteria vary.

3. Licensed home care agencies employ a variety of home health care professionals serving clients with skilled nursing care- hourly and visits, therapy care as well as home health aides. This type of care is typically paid for by private insurance, Medicare and Medicaid.

4. Medicare-certified skilled home care is typically received on an acute, intermittent basis following an illness, injury or change in disease status. Such services are physician-driven and reimbursement is contingent on the individual demonstrating progressive improvement while being homebound.

Who Pays for Home Care?

Funding for home care is increasing as more people recognize its cost competitiveness. Many insurance companies now cover extended hour nursing and care visits. A tracheotomy patient, for example, can be approved for 24 hours per day care for one month and then weaned onto family care. Managed care companies, such as Medica, Health Partners, UCare and Blue Cross/Blue Shield, have come to understand that home care is both safe, efficient and provides the same level of care at a cost effective rate.

Payment options for home care include Self-pay, Medicare, Medicaid, Veterans Administration, Community Organizations, Commercial Health Insurance Companies, Managed Care Organizations. CHAMPUS and Workers’ Compensation.

A Cost-Effective Alternative

According to a recent Ecumen survey, home care is the preferred care choice for 90% of seniors and retiring Baby Boomers. It is one viable solution that state legislators can leverage to maximize care capacities while minimizing costs.

In 2009, national charges by Medicare were $135 per home care visit, $622 per day for skilled nursing facilities and $6,200 per day for inpatient hospital care. The average monthly cost of home care aid for seniors is now $764 per month while the average monthly cost of similar care at nursing homes is $4,890. The numbers speak for themselves.

Home care is a critical component of collaborative care that is moving from the periphery to the mainstream. Home is where families want their loved ones to be and it’s where quality of life for patients can best be had.

Amy Nelson is Founder, President and COO of Accurate Home Care, the leading provider of quality home care services in the Upper Midwest. AHC serves a wide range of medically complex pediatric and adult clients in Minnesota, Iowa and Illinois. Amy can be reached at 763.633.3800 or amynelson@accuratehomecare.com.

Age in Place | The National Aging in Place Council
ageinplace.org