Autumn Newby
Home Health Care
2/17/18
Professor Callahan-Kapor
Definition and Background
Home Health Care is an ample amount of services provided to patients in their homes by nurses, physical therapists, speech therapists and social workers (Jarrín et al.)..This care is given only through the directions of a doctor (Jarrín et al.).The treatment is more cost-effective, suitable, and mainly offers the same caliber of the hospital or certified nursing care.The main goal of home health care is to not only treat the individual but to make them more independent and also to keep people in the community and avoid being hospitalized.With home health care, the patient has more access to family members and personal belongings.On the other hand, a good percentage of these patients live alone, making it more difficult for the caretaker because they lack the help and support of family members.Much of the population who participate in home health care are the elderly or individuals over the age of 65 (Landers et.al).An article by Home Health Care Management and Practice states,” America is experiencing a dramatic shift in demographics, and in 2019, people older than 65 years will outnumber those younger than five.” (Landers et.al).The standard of living and life expectancy is getting better progressively so, there are more people living with chronic diseases such as Alzheimers.83% of the elderly who have these services have 3 or more chronic conditions or are functionally limited, making them harder to treat on a daily basis (Jarrín et al.).Due to the demographics changing, home health care is growing rapidly and the number of patients being treated in their homes has greatly increased.Just documented a few years ago, there were about 12,000 home health care agencies and 4.5 million people being treated through Medicare and Medicaid annually.(Jarrín et al.).In order to avoid paying out of pocket, patients must have insurance to be eligible to receive home health care.Medicare and Medicaid are the two main insurance agencies that provide these services to the patient.Along with these two insurance agencies are multiple other agencies who fund home health care as a whole.Medicare is the single largest payer in home health care.According to CMS,sources for home health payment in 2006 were as follows: Medicare (37%),state and local government (19.9%),Medicaid (19%),private insurance (12%),and out of pocket (10%).(Murkofsky and Alston,2009).Hospital bills can be very expensive, so home health care can provide a more cost-effective way of receiving medical care through the use of various insurance companies.
“Out with Nursing Homes, in with Home Health Care.Digital image. Modern Healthcare” (Tepper, 2017). This image depicts an in-home nurse providing care in the home of an elderly woman.
Physicians play an important role in home health care even though patients are usually treated by certified nurses and therapists.Home care must be referred by a medical doctor and they must oversee the services and have constant contact with the caretakers and patients.Those who work in the home with the patients must report changes in patient status to the medical doctor and only the physician can prescribe medicine to patients.In some cases where a patient has an illness that puts a limit on their life expectancy, physicians encourage the idea of hospice.Some patients prefer comfortably dying in the comfort of their own homes, which can also be a branch of home health care, as nurses continue to care for the patients and make them as comfortable as possible.In order to be eligible for this physician referral, patients must be homebound, have a safe home, need health care and the care must be ordered by a doctor (Murkofsky and Alston,2009).Homebound refers to difficulty leaving one’s home, such as needing a wheelchair or having disabilities that make physical function challenging.A safe living arrangement is imperative because the patient must be able to easily receive care in their home.The video below demonstrates the processes involved in home health care and hospice.
Video: https://www.youtube.com/watch?v=PIU2SLOjYOk
Historical Context
Home health care dates back to the 1900’s when rich women would have nurses and caretakers visit the sick and poor in their homes to treat them (Murkofsky and Alston,2009).This care was free due to the fact that they could not pay for the care themselves.Most of the patients who received home health care at this time had chronic illnesses.The care provided to these patients were mainly funded charity and contributions (Murkofsky and Alston,2009).In 1965, the Social Security Act signed Medicare as a form of health care coverage that extends services, including home health care for mainly elderly individuals.Since Medicare began covering this service, the number of people participating in home health care began increasing significantly.Because numbers were increasing, the home health care system called for the Omnibus Reconciliation Act of 1980, which removed limits on the number of home care visits, prior hospitalization requirements, and deductibles and extended participation in Medicare home care to for-profit home health agencies (Murkofsky and Alston,2009).By 1997, the number of home health care agencies increased by 8,000 and Medicare was spending 350% more on services.Although Medicare was an important part of the health care system, Medicaid also played a vital role.Medicaid, which was also coined in 1965 provided health care to people who were poor and unable to work and extended the care for long periods of time (Murkofsky and Alston,2009).There are many individuals who are of old age or are physically impaired by their chronic illness which does not allow for them to work, which is the main reason for Medicaid insurance.These patients can be treated in their homes and do not have to be hospitalized and pay a numerous amount of bills.Due to the fact that home health care increased at a rapid rate, in 1997 Congress saw the need to implement a spending system that made eligibility stricter and lowered the amount the government was spending on home health care.As a result of budget and funding cuts, over a third of home health agencies closed (Murkofsky and Alston,2009).While Medicare provided care for the elderly, Medicaid cared for poor individuals.Increased spending on home health care in the Medicaid department led to improvements in the quality of care.The OASIS database tracked socio-demographic, environmental, support system, health status, and functional status data (Murkofsky and Alston,2009).Another program that focused on the improved quality and safety of home health care was the Medicare Quality Improvement Organization Program.Improvements in home health care created a less expensive, more convenient way of treating patients other than extended hospital stays.This system is usually preferred over hospitalization, urgent care/emergency room care, and nursing homes
“UNDERSTANDING MEDICARE AND MEDICAID DUAL ELIGIBILITY” (Debruyckere Law Offices, 2016). This image shows the differences between Medicaid and Medicare and the people who are eligible for this insurance which aids home health care.
Perspectives
Proponents of home health care are mainly attracted to the lower costs in contrast to admitting a patient to the hospital for an extended amount of time (Keefer,2017).Hospital bills can be extremely costly, but home health care provides patients with an alternative source of care after being discharged from hospitals if their care needs to continue.Many people are not able to pay for hospital care if they have a chronic illness.On the other hand, others may say that the medical bills for home health care will eventually add up, especially if care is prolonged because of home health care charges per visit.Not only do patients have to pay for care, they also have to pay for maintaining their homes and making them efficient and accessible enough for home health care (Keefer,2017).Another aspect of this health care service is the independence that comes with residential care.Being in your own home increases comfort and a feeling of safety among patients.Though a doctor’s consent is needed, patients can be more proactive in their own care.However, independence is not always good because patients can begin to feel isolated due to not leaving their houses much and being content with not leaving their beds.Many elderly people need the comfort of other people whom they can interact with (Keefer,2017).Furthermore, the quality of healthcare with regards to the home health care system can be advanced in that the patient receives meticulous attention in contrast to nurses working in a hospital who see hundreds of patients in a day (Ropchan,2014).The nurses who work in home pay closer attention to their patient’s health and treating them.On the other hand, while this one on one attention may be good, there is also much room for error, abuse, or neglect.Often times there is no one monitor in-home nurses, so they can easily neglect their ill patients.Some families may not be a fan of leaving their family member with caregivers in the home with no supervision.With regards to families, however, they are used a great deal in the home health care system.Family members do not only have to rely on the care of hospital doctors but can be actively involved in the care of their family member (Keefer,2017).People are advocates of this aspect of the system because they know exactly what is going on with the patient and do not have to be filled in by doctors and nurses.Due to the fact that the care takes place in the home, those living there can see them daily and do not have to wait in waiting rooms or follow hospital rules and regulations.A lack of family care can be a downfall of the home health care system because in-home caregivers partially rely on the support and care of family members.This also leaves no one to monitor the caregiver and makes it harder to deal with in-home emergencies.
Being in the comfort of your home and already being accommodated with the arrangements makes it easier to provide care to patients (Ropchan,2014).This also provides a sense of normality in their lives and they do not have to feel like they are being held captive in a hospital bed for an extended period of time.Moreover, not all homes are user-friendly or designed to assist handicapped, ill, or physically challenged individuals.Hospitals provide ramps, railings, elevators,etc.while homes lack these items, making it harder to get around the house.Adding these elements to one’s home may be very expensive.Another aspect of the non-accessibility of one’s home is the lack of emergency resources (Ropchan,2014).In a hospital, patients are set up to be quickly treated if emergency strikes, but in a home, they do not possess the same resources.The caregiver would have to try to maintain one’s health while attempting to get an emergency vehicle to the premise to treat the patient and bring them to the hospital.Nurses are not specifically trained to deal with major medical emergencies.The video posted below depicts the expectations for in-home nurses with regards to the care they provide for their patients.
Video: https://www.youtube.com/watch?v=Gqzxn-AYWcc
Relation to POH
The increased power over one’s form of treatment and decision to participate in a hospice in one’s home that comes with the system of home health care demonstrated Michael Foucault’s idea that each person should have control over his or her own life and death. He describes this as “power of life and death” (Foucault, 136). By receiving care in the home, the patient has more say over how things are done than they would if they were hospitalized. Additionally, partaking in hospice at home gives more power over life and death because the non-curable illness a person has will take their life in due time, so the decision to die in a more comfortable place shows their sense of control. Furthermore, Foucault also believes that the world was not made to have so many rules and regulations. Sovereign power had the right to who died and who lived according to laws put in place, and he believes this power has been shifted to individuals. They were not meant to follow these rules and regulations as they only cause issues. His ideas reflect home health care in that there are fewer rules and regulations to follow. Patients are no longer in hospitals and do not have to follow the strict hospital regulations. Because they are now receiving care in the home, they have more say over what happens in their home. Another aspect of Foucault’s ideas is the concept of biopower which is power over other bodies and control of the population. An article by Tailoring Biotechnologies states, “power and knowledge begin to take into account the “processes of life” and the possibility of controlling and modify- ing them” (Lazzarato 2006). With regards to home health care, the nurses who work in the home have a sense of control over their patients because a majority of the time it is just them and the patient in the home. They have control over the medical aspects of the patient’s life, which is a large majority of their life especially if they are living with a chronic illness (Lazzarato 2006). On the other hand, the sense of power over populations can be shown in hospitals as they take away people’s sense of independence because they are at the mercy of the hospital. When it comes to home health care, it helps to restore this sense of independence in patients because they are in the comfort of their homes and have a say in some aspects of their care (Lazzarato 2006).
References
Genel, Katia. “The Question of Biopower: Foucault and Agamben.” Rethinking Marxism, vol.
18, no. 1, 2006, pp. 43–62., doi:10.1080/08935690500410635.
Jarrín,Olga,et al.“Home Health Agency Work Environments and Hospitalizations.” Medical
Care,vol.52,no.10,2014,pp.877–883.,doi:10.1097/mlr.0000000000000188.
Keefer,Amber.“Home Health Care Advantages & Disadvantages.” LIVESTRONG.COM,Leaf
Group,14 Aug.2017,www.livestrong.com/article/79680-home-health-care-advantages-.
Landers, Steven, et al. “The Future of Home Health Care.” Home Health Care Management &
Practice, vol. 28, no. 4, May 2016, pp. 262–278., doi:10.1177/1084822316666368.
Lazzarato, Maurizio. “From Biopower to Biopolitics.” Tailoring Biotechnologies, 2006, pp. 11–20., www.artcentersf.org/fall2016/parallaxdrift/wp-content/uploads/2017/04/2_2_lazzarato.pdf.
Murkofsky,Rachel L.,and Karen Alston.“The Past,Present,and Future of Skilled Home
Health Agency Care.” Clinics in Geriatric Medicine,vol.25,no.1,2009,pp.1–17.,doi:10.1016/j.cger.2008.11.006.
Ropchan,Jason,and Your Tribute.“Home Health Care Advantages and Disadvantages – Your
Tribute.” Advantages and Disadvantages – Your Tribute,21 Mar.2014,resources.yourtribute.com/home-health-care/home-health-care-advantages-disadvantages/.
Tepper,Nona. Out with Nursing Homes, in with Home Health Care.Digital image. Modern
Healthcare.N.p.,17 Aug.2017.Web.17 Feb.2018.<http://www.modernhealthcare.com/article/20170817/NEWS/170819912>.
UNDERSTANDING MEDICARE AND MEDICAID DUAL ELIGIBILITY.Digital
image. Debruyckere Law Offices.N.p.,19 Jan.2016.Web.17 Feb.2018.<https://dadlawoffices.com/blog/elder-law/medicaid-planning-elder-law/understanding-medicare-and-medicaid-dual-eligibility-2/>.
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