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Home care in the United States

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See also: Caregiver, Caregiving and dementia, Family caregivers, Health care provider, Long-term care, and Personal care assistant

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 care needs or by professional caregivers who provide daily care to help to ensure the activities of daily living (ADL's) 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 is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel.[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 (LPNs), physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), home health aides (HHAs) and medical social workers (MSWs) as a limited number of up to one hour visits, primarily through the Medicare Home Health benefit.[2]

The largest segment of Home Care consists of licensed and unlicensed non-medical personnel who assist the individual including caregivers.[3] Care assistants may help the individual with daily tasks such as bathing, eating, cleaning the home and preparing meals. Caregivers work to support the needs of individuals who require such assistance, and this care helps them stay at home versus living in a facility. Often 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 has traditionally been privately funded as opposed to Home Health Care that is task-based and government or insurance funded. These traditional differentiations in Home Care services are starting to change as the average age of the world's population has increased. 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.

For terminally ill patients, home care may include hospice care. For patients recovering from surgery or illness, home care may include rehabilitative assistance.[4]

United States

Professionals providing care

Professionals providing home care include licensed practical nurses, registered nurses, home health aides, physical therapists, occupational therapists and social workers. Rehabilitation services may be provided by physical therapists, occupational therapists, speech and language pathologists and dietitians.[citation needed] Professionals can be independent practitioners, part of a larger organization, or part of a franchise.

Home care aides, Certified Nursing Assistants (CNA's), 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, and do various other errands.[5]

Concept

"Home care", "home health care" and "in-home care" are phrases that are used interchangeably in the United States to mean any type of care given to a person in their own home. These phrases have been used in the past interchangeably regardless of whether the person required skilled care or not. More recently, there is a growing movement to distinguish between "home health care" meaning skilled nursing care (usually provided by a Home Health Agency) and "home care" (provided by Home care Agency or independent home health aide or caregiver) meaning non-medical care.[citation needed]

Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home care providers deliver services in the client's own home. These services may include some combination of professional health care services and life assistance services. Professional home health services could include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy. Richard A. Kimball, Jr. of HEXL highlights preventive medicine at home in order for patients to fully use their medical benefits, particularly those with chronic diseases. Life assistance services include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship. 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.[6]

  • 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) refers to daily tasks, including light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone, and managing money, that 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.

"The Woman as Family Doctor", by Dr. Anna Fischer-Dückelmann

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.

Home Health Software

Main article: Home health care software

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”[7]

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 does not have licensure for non medical or custodial care services, and as such there are no entry requirements or minimum standards.

Full service agencies do preemployment 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.[8]

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 ADL's can be provided by a home health agency or nurse registry. The state licensing authority is the Florida Agency for Health Care Administration.[9]

Compensation

Compensation varies according to discipline, but the Bureau of Labor Statistics estimates that the 2012 median hourly wage for home health aides was $10.01 per hour with the median annual wage of $20,820.[10]

Supreme Court case relating to fees

Since 1974, home care work has been selectively 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, which stems from a case brought by a home care worker represented by counsel provided by Service Employees International Union. The original 2003 case, Evelyn Coke v. Long Island Care at Home, Ltd. and Maryann Osborne, argues 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 has done that. Since the DOL has followed public notice procedure, and since there was gap left in the legislation, the DOL's regulation stands and home health care workers are not covered by either minimum wage or overtime pay requirements.

Department of Labor Rule

A rule issued from the Department of Labor, entitled "Application of the Fair Labor Standards Act to Domestic Service," and meant to be effective from January 1, 2015, would 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. 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 recordkeeping provisions."[12] However, Home Care Associates of America, the International Franchise Association (IFA), and the National Association for Home Care & Hospice sued the Labor Department in regards to the rule, and a federal district court threw out the rule.[13] The Labor Department then appealed.[13]

Statistics on consumers

Payment

710,000 paid by Medicare - 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.[citation needed]

235,000 paid by private insurance, or self/family - 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]

The United Kingdom

see Home care in the United Kingdom

India

See also: India Home Health Care

Professionals providing care

There are professionals and organised companies providing home health care services.[14][15]

Research and program accreditation

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.[16] Modin and Furhoff regard the roles of patients' doctors as more crucial than their nurses and care workers.[17] However, from an epidemiological standpoint, the risks of some community acquired infections are higher from home nursing than from inpatient nursing home care.[18] In regards to financial expenditure, home nursing care is more cost effective than inpatient nursing home care.[19] The quality aspect of home nursing has been reviewed by Riccio.[20] Christensen & Grönvall study the challenges and opportunities of providing communication technologies supporting the cooperation between home care workers and family members. 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.[21]

See also

Notes

  1. ^ "www.Homecare.com". www.Homecare.com. Retrieved 10 March 2012.
  2. ^ "Home Health services" - BAYADA Home Health Care retrieved 2013-07-19
  3. ^ "Caregiver". The Free Dictionary By Farlex. Retrieved 15 June 2012.
  4. ^ "DEFINITION OF CARING FOR ELDERLY". LiveStrong.com. Retrieved 15 June 2012.
  5. ^ "Cooking Games". Didi Games Assosciation. Retrieved 10 March 2012.
  6. ^ "Hospital to Homecare". Hospital to Homecare. Retrieved 10 March 2012.
  7. ^ Brailer, T; Thompson, D (2004). "Health IT strategic framework". Department of Health and Human Services.
  8. ^ "CAHSAH". Retrieved 15 May 2014.
  9. ^ "AHCA". Fdhc.state.fl.us. Retrieved 10 March 2012.
  10. ^ "Occupational Employment and Wages, May 2012" Retrieved 19 July 2013
  11. ^ Martin, Douglas (10 August 2009). "Evelyn Coke, Home Care Aide Who Fought Pay Rule, Is Dead at 74 (New York Times Aug.9, 2009)". Nytimes.com. Retrieved 10 March 2012.
  12. ^ "Application of the Fair Labor Standards Act to Domestic Service" (PDF). Retrieved 20 November 2013.
  13. ^ a b "Judges weigh minimum wage, overtime rules for home care providers". TheHill. Retrieved 11 May 2015.
  14. ^ "US firm Bayada buys 26% stake in Chennai's India Home Health Care". The Economic Times. Retrieved 4 January 2014.
  15. ^ "India Home Health Care partners with Bayada for professional home health care service in India". Retrieved 4 January 2014.
  16. ^ 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.
  17. ^ 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. Retrieved 27 July 2008.
  18. ^ 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. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help)
  19. ^ Paul, Ian M.; 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. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help); Unknown parameter |author-separator= ignored (help)
  20. ^ 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. Retrieved 27 July 2008.
  21. ^ 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. Retrieved 24 July 2013.

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