In the health care industry, home health care and nursing demonstrates a rapid growth, with sixty-six percent rise expected in the next ten years. Notably, the home health care sector is significantly large and employs over 1.3 million staff in diverse occupations. The largest part of the evident growth took place following the year 1965 enactment of Medicare. All the same, more intense progress ensued after the amendments to Medicare in 1987. The amendments steered facilitated repayment to home care agencies, thus allowing them guarantees in payments for services rendered. In the year 2005, the home health care and nursing expanded as the agencies provided care to around eight million people. As Landers et al., 2014 argues, the figure was most likely a representation of just a section of the exact number of individuals in the home care nursing since lots of patients obtain informal care through agencies that are non-Medicare-certified.
The rise in need for home health care is progressively driven by sustained efforts aimed at reducing medical costs. These efforts began in the late 1980s following a countrywide campaign to decrease medical costs that resulted in reduced duration of health facility stays. The effect was the promotion of practices that saw early discharge of numerous patients and linking them to home health care for continued monitoring of their conditions (Institute of Medicine, 2015). For instance, in the year 2003, the average hospital stay was 4.8 days after which patients were discharged. On the contrary, the average hospital stay in 1990 was an average of 6.4 days. In year 2000, forty-eight percent of patients discharged under Medicare were connected to home health care to continue with their medication. Currently, home health care is a globally acknowledged approach for attaining a cost-effective system that promotes patient fulfilment, a reduced burden on the occupancy rates in hospital beds as well as reducing the rates of hospital infections (Institute of Medicine, 2015).
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Notably, home health care and nursing makes use of home care nurse practitioners and physicians to deliver healthcare services at the home level. For most of the time, this mission is accomplished with joint efforts from home health professionals that form an all-encompassing interdisciplinary team. Home health makes use of clinical teams comprising of healthcare professionals across various disciplines such as medical occupational therapists, social workers, home health aides, nurses, and physical therapists among others (Institute of Medicine, 2015). The major aim of home health care is to supersede hospital admittance for particular category of patients through the provision of intensive care at home in a similar manner to hospitals. Individuals in receipt of the home health care at the utmost acuity level have been shown to experience lower health care expenditures, with greater satisfaction, and equal or better outcomes when paralleled with alike inpatients.
More often than not, the majority of the recipients of home health care and nursing are individuals aged beyond sixty five years. With this in mind, the demographic situation in America points out a projected expansion in the clientele receiving these services. Landers et al., 2014 points out that by year 2019, the demographics will shift towards an even older population with people above the age of 65 years outnumbering infants and young children below the age of five years. Further, as the life expectancy increases, the elderly people show disease susceptibility from the effects of a deteriorating immune system. In fact, Landers et al., 2014 states that growing numbers of elderly people “will live with multiple chronic conditions, such as diabetes or dementia, and functional impairments, such as difficulty with the basics of life like mobility and managing one’s household”. As such, the major challenge for the health care industry is in making certain that elderly people with severe chronic ailments and other disorders that come with aging remain independent. At this point is where the home health care and nursing comes in to fill the gap.
Notably, home health care and nursing provides a variety of medical services in the same capacity as in hospital settings. Other than these wide-ranging health services along home health care, it is as well essential to make mention of the massive role played in offering palliative care for the elderly. For individuals who have been diagnosed with severe and life threatening illnesses such as cancer, palliative care is constantly a core component of patient treatment in an all-inclusive approach that puts emphasis on bodily functions. Currently, Medicare allows palliative care to be delivered outside of the hospital settings enabling the patients to access home health care and nursing. Moreover, with the substantial growth in utilization of home health care due to the reforms in delivery and payment, the need for such services remains on the rise. Payment restructuring results in motivation for upstream referral facilities to make use of home health more substantively since it is a lower cost situation for individuals in need of post-acute health care.
The need for home health care and nursing is also orchestrated by the preferences of most of the patients. It is evident that patients have a preference towards obtaining health care while at home. The Alliance for Home Health Quality and Innovation, 2014 states that “surveys of older Americans have found that most prefer to stay in their own homes”. Furthermore, the economic trend is largely towards on-demand, personalized, and direct-to-consumer services. As such, similar trends are expected in the health care industry as shifts are likely to occur in the manner of consumer demand for health care services. Although uncertainties manifest regarding the scope of home based nursing, the system is ultimately moving in the direction of wide-ranging use of home health. Landers et al., 2014 points out that an increase in home health agencies that are certified by Medicare seem to be orchestrated by the rising demand for their services. Most of these agencies are specialists in the provision of skilled, home based nursing and therapy services to patients who are homebound. Some of their services target patients who have gone through hospitalization and are recuperating from severe infections or conditions. They also target patients who require community-based care to manage their prolonged health conditions. Currently, home health agencies serve a unique role as the single Medicare providers who are specially licensed to deliver skilled care to recipients at home for chronic, acute, or rehabilitative illnesses.
Under the prospective payment system for home health and nursing, beneficiaries in Medicare are entitled to obtain home health care services. What is more is that such services need to be delivered by a home health agency that is certified by Medicare. The major factors for consideration are the homebound beneficiary, the need for recurrent skilled nursing with or without the inclusion of therapy services. Moreover, the beneficiary, though under a physician’s care requires sound, essential home health services after the certification of the same by a physician and outlined in the plan of care. Given that Medicare is fully supportive of home health care, the federal government has embraced the value-based system which is largely on home health and nursing. In fact, the emphasis is on the value and quality of health care as outlined by key healthcare measures. The world health organization, 2015 maintains that the policy emphasis today is on realizing the Triple Aim in health care. Under the Triple Aim, the key issues are “better population health, better patient experience, and lower per capita cost” (WHO, 2015). As the health system progressively embraces home health and nursing, the scope of services rendered is likely to increase. On the other hand, the agencies progressively may possibly require the partnership of entities in handling health care risks. This process is likely to be a gradual one as additional agencies develop the know-how and capacity to comprehensively accomplish home health care and handle the associated risk.
In conclusion, the need for home health care is progressively growing as the life expectancy increases. As such, there are sustained efforts towards making home care further flexible and responsive to meet the needs and aspirations of the population. Currently, Medicare allows palliative care to be delivered outside of the hospital settings, enabling the patients to access home health care and nursing. All the same, provision of home health care services need to be designed to address the requirements and sought after outcomes of the service beneficiaries. As discussed above, home health makes use of clinical teams comprising of healthcare professionals across various disciplines such as medical occupational therapists, social workers, home health aides, nurses, and physical therapists among others. As such, a challenge presents in evaluating the quality of care from the multidisciplinary approach employed in rendering home health care services. Moreover, the vulnerable situation that the patients present in make it more challenging to monitor them as opposed to health care settings such as hospital wards.
References
Institute of Medicine. (2015). The Future of Home Health Care: Workshop Summary. Accessed September 14, 2017 http://www.nap.edu/catalog/21662 .
Landers, S., Madigan, E., Leff, B., Rosati, R. J., McCann, B. A., Hornbake, R., & Lee, T. (2016). The Future of Home Health Care: A Strategic Framework for Optimizing Value. Home health care management & practice , 28(4), 262-278.
The Alliance for Home Health Quality and Innovation. (2014). The Future of Home Health Care Project .
The World Health Organization. (2015). The growing need for home health care for the elderly.
