In the year 2000, about 12,800 home health agencies served approximately 8,600,000 clients across the United States . In that year Medicare paid an estimated 85% to 90% of the total cost of home health agency services amounting to $ 8,700,000,000. Although current figures are not yet available, the number of home health agencies has been going up year after year as well as the number of clients being served.
Although home health agencies are privately owned, Medicare is the principle payer for their services. Home health services through Medicare are available under parts A and B. In order to qualify for Medicare homecare a person must have a skilled need, must be homebound and there must be a plan of care ordered by a Physician.
Prior to 1997 Medicare typically paid for home care for as long as it was needed. Prior to 1997 annual Medicare costs were almost double the amount cited above. In order to save money Medicare has since gone to a prospective payment system where, according to the plan of care, a certain amount of money is allocated to resolve the skilled need for the patient.
Monies are typically provided for a period of up to 60 days. If the patient recovers sooner then money may have to be reshuffled to other patients who are not responding as well. At the point where the patient does not respond or improve, no more Medicare money is forthcoming. After Medicare cuts off, a person continuing to need long-term care services must find sources other than Medicare.
Home health agencies deliver a variety of skilled services. The plan of care usually includes custodial services to help the care-recipient remain in the home. These would include an aide for an hour or two a day to help with bathing, dressing and transferring. If there is time remaining other personal services may be offered as well.
Recently Medicare has redefined what it means by "homebound" to allow recipients to leave the home on a limited basis. Beginning in 2003 and ending three years later, Medicare is testing, with a very small test group, a program where selected home health agencies can provide adult day health care instead of home health services. If successful the program will offer a new dimension in Medicare home care.
In addition, under the new definition, Medicare will also allow and pay for home visits from doctors who specialize in homebound elderly patients. Limited office visits are also allowed under the new definition. Finally, in the past few years Medicare is paying for home telehealth visits through a home telehealth, computer work station. Telehealth is being used with some success to provide home care in rural areas where it would be difficult to arrange the personal visit from a home health care agency.
Personal Care or Non-medical Home Health Care
Non-Medical Care Services In The Home.
These providers represent a rapidly growing trend to allow people needing help with long term care to remain in their home or in the community instead of going to a care facility. The services offered may include:
- grooming and dressing
- recreational activities
- incontinent care
- handyman services
- teeth brushing
- medication reminders
- bathing or showering
- light housekeeping
- meal preparation
- respite for family caregivers
- errands and shopping
- reading email or letters
- overseeing home deliveries
- dealing with vendors
- transportation services
- changing linens
- laundry and ironing
- organizing closets
- care of house plants
- 24-hour emergency response
- family counseling
- phone call checks
- and much more.
A search of your local Yellow Pages under "home health agencies (or services)" will reveal that a large number of the advertised providers are personal care or non-medical home health companies. This causes some confusion since the yellow pages choose the same classification to list non-medical and traditional home health agencies together.
Personal care agencies are different from traditional home health agencies in that they do not provide medical services or skilled services and they are not paid by Medicare.
In addition, many states do not require personal care agencies to license with the state health department. In some states a person desiring to start a business like this need only advertise, get a business license and start hiring employees. On the other hand, some states require these companies to meet the same stringent rules under which traditional home health agencies operate. This might include hiring trained employees, the use of care plans, periodic inspections by the state health department and bonding.
If you live in a state which does not require regulation of these companies, it is important for you to check the background and history of these providers before using their services. Another benefit for the public is that many of these companies are part of a national franchise system. There are a number of these home care provider franchises around the country. Being a franchise, it is more likely that you can trust the services of the company and not have to worry about theft or abuse with your loved one.
Many larger traditional home health agencies are integrating non-medical services into their care delivery. This means Medicare and Medicaid are not paying the bill for this portion of a home health agency's business. Also many large integrated facilities providers (combined nursing homes, assisted living and independent retirement arrangements) are offering more non-medical or personal home healthcare.
The number of these companies is literally mushrooming all over the country. It is evident from this growth that there is a growing need for traditional family caregivers to contract help from paid care providers. This is probably due to the fact that many of the traditional caregivers are now employed fulltime or are living a long distance away from their loved ones and find it difficult if not impossible to provide long-term care.
Home Repair And Maintenance Services
As a general rule most personal care agencies provide only aides to help with personal needs in the home. Very few offer such things as deep housecleaning, home repairs, remodeling or yard maintenance. There is now a growing trend for companies to specialize in providing these additional services for the elderly. And as with personal care agencies many of these belong to national franchises.
It is evident that there is a growing national need to provide services to allow people to remain in their homes as long as possible. The growth of companies providing these services is evidence that this is a preference for the elderly needing care in the community.