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Introduction

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"We are what we repeatedly do. Excellence, then, is not an act, but a habit."

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—Aristotle

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LEARNING OUTCOMES

By the end of this chapter, readers will be able to:

  1. Understand the history and influences on the home health-care arena.

  2. Describe the services covered under the Medicare home health-care benefit.

  3. Cite the eligibility criteria a beneficiary must meet to qualify for home health care.

  4. List and explain regulations and legislation that drive home health care with emphasis on therapies.

  5. Describe the payment and audit challenges specific to therapy in home health care.

  6. Explain the competency and documentation requirements for a home health-care therapist.

  7. Describe the OASIS tool and its use and purpose in the home health-care arena.

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Clinical Vignette

Omar Ali Bey is a 68-year-old retired postal worker who lives in a small two-story bungalow in an inner-city neighborhood. The home has three bedrooms and one bathroom, all on the second floor. He has had diabetes for 3 decades and recently underwent a left, below knee amputation secondary to his diabetes. Mr. Bey was fitted with a prosthesis, had 2 weeks of inpatient rehabilitation with physical therapy and occupational therapy, and has now been discharged to his home. His wife, also 68, has rheumatoid arthritis and macular degeneration and struggles to take care of herself. Their three children live within several miles of them but have full-time jobs and adolescent children at home; although the family is emotionally close and supportive, the children have limited time to provide instrumental assistance.

  1. What are some issues that are of immediate concern regarding Mr. Bey's ability to manage in his home?

  2. Are there roles for occupational therapy and physical therapy in addressing those issues once Mr. Bey is discharged from the hospital, and if so, what might that role be?

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Home health care has grown in popularity in the United States and around the world (Kuluski, Williams, Berta, & Laporte, 2012) because it has proven to be a cost-effective and quality-measured option for patients with illness, injury, or other conditions, often due to older age, disability, or chronic conditions. As the aging population increases and the availability of informal caregivers, friends, or family members to assist diminishes, the need for home health-care services grows. In addition, factors such as increased use of technology, surgical and pharmaceutical advances, and better understanding of epidemiology and disease patterns have all contributed to increasing life expectancy and quality of life, allowing more persons to remain at home (Palm, 2014).

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Image not available. AROUND THE GLOBE: Home Health Care in Europe

In Europe, the development of "home nursing and home help are bound up with the emergence of complex systems of welfare, social security, and health care that have followed different trajectories and given rise to different patterns of funding and provision within each country" (Tarricone & Tsouros, 2008, p. 9). Tarricone and Tsouros, in this ...

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