Home Care in the US
What Is Home Care
Home care is care provided to individuals in their own residences. The goal of home care can be a long-term provision of supportive care and services to chronically ill clients to avoid hospitalization. Or, home care can act as short-term intermittent care of clients after an episode of illness or hospitalization.
Home care may be provided through the formal system of agency-employed professional home care providers such as registered nurses, licensed practical nurses, home health personal care aides, physical therapists, occupational therapists, speech-language pathologists, social workers, and homemakers—all making visits to the home. A considerably smaller number of home care staff may be self-employed individuals who contract privately with clients. An informal system also provides home care through caregivers consisting of family, neighbors, and friends. Very often, a combination of both formal and informal systems deliver home care.
When Did the Home Care Industry Start?
Professional home care services originated in social welfare initiatives in the early 1900s. After Medicare’s enactment of reimbursement for home care services in 1965, the number of home health agencies grew more than threefold to 5,983 between the years 1967 and 1985, with public health agencies dominating the industry (Basic Statistics About Home Care 2010).
In the late 1980s, significant growth in the number of agencies ceased due to Medicare reimbursement issues (Basic Statistics About Home Care 2010). However, with Medicare reimbursement changes in the 1990s, the number of for profit home health agencies grew rapidly (Basic Statistics About Home Care 2010). The home care industry expanded its scope of services in response to demographic, economic, and legislative changes that include:
An increase in the number of older persons and their expressed desire to remain in their own homes for care whenever possible
Decreased numbers of informal caregivers that are available to provide in-home care to their relatives
Increased innovations in high-technology home care that have redefined and expanded the categories of disease and chronic conditions that can be cared for effectively in the home
Medicare and Medicaid reimbursement that supported expanded coverage
The 1999 Olmstead decision of the Supreme Court that upheld the right of citizens to receive care in the community
The Cost of Home Care in the US
In 2013, about 3.5 million Medicare beneficiaries received home health services from 12,613 home health agencies (Medicare Payment Advisory Council 2015). Medicare remains the largest payer of home healthcare services accounting for almost 42 percent of the total annual home care expenditures (Centers of Medicare and Medicaid Services 2020).
The informal care system provides a valuable social service at little or no public cost. This is still the most used system of long-term care as family members care for more than 80 percent of the older adults needing some level of assistance. The informal care system offers significant savings to the public. However, the potential for caregivers to suffer physical and emotional burnout and the growing inability of family caregivers to fully manage care without outside assistance have begun to diminish these savings. Family caregivers frequently are required to compromise their finances, lifestyles, and personal freedom to care for family members. The costs can be high, and the stresses the caregiver experiences can lead to exhaustion, illness, and depression (“Caregiving And Ambiguous Loss” 2021).
Basic Statistics About Home Care. 2010. Ebook. Washington, D.C.: The National Association for Home Care & Hospice. http://www.nahc.org/wp-content/uploads/2017/10/10hc_stats.pdf.
“Caregiving And Ambiguous Loss”. 2021. Family Caregiver Alliance. Accessed August 15. https://www.caregiver.org/resource/caregiving-and-ambiguous-loss/.
Centers of Medicare and Medicaid Services. 2020. “National Health Expenditures By Type Of Service And Source Of Funds, CY 1960-2019”. Washington, D.C.: Centers of Medicare and Medicaid Services. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.
Medicare Payment Advisory Council. 2015. “Report To Congress Medicare Payment Policy”. Washington, D.C.: Medicare Payment Advisory Commission. http://www.medpac.gov/docs/default-source/reports/mar2015_entirereport_revised.pdf.