Chapter 16: Management Issues in Home-Care Organizations

Learning Objectives

Part 1 The Contemporary Setting

Overview of Home Care

Home care is that broad array of professional and paraprofessional services, post-acute and long-term care, with medical and social services provided in nonmedical, residential settings that include two broad parallel and interrelated functions: ¹

• Social and supportive services: Their purpose is to keep the person in the home and as functional as possible by providing personal care. This type of home care is often uncompensated care provided by family and friends. If additional supportive assistance is needed, it is more often than not paid for out of pocket. These paid services do not require a high level of skill. Contrary to popular impressions, it may be more expensive than institutional care if it is needed 24/7 and the client is severely dependent.

• Post-acute services: These services may be episodes of care of varying lengths, which include intermittent, short-term visits by health professionals. They are professional, skilled services; therefore, reimbursement by Medicare, Medicaid, and other health insurance policies applies.

Although care of the sick and elderly in their homes is not new, it is only recently that home care became an important part of the business of healthcare. People of all ages who have a wide range of physical and mental impairments receive home care. For example, working-age adults who are commonly receiving Medicaid benefits and children make up 40% of home-care patients.¹

Based on 2009 statistical data prepared by the National Association for Home Care & Hospice, there are an estimated 33,000 home health provider organizations—10,500 are Medicare certified and 9,000 of them are freestanding organizations. Home health provider organizations deliver care to 12 million people in the United States and employ about 1 million people. Physical therapy staffs make up 26,000 of these employees, and they average 5.39 patient visits per day. These organizations supplement rather than replace the informal, unpaid care that families, neighbors, and friends provide in the home. One in three households has informal caregivers (66 million people caring for both children and adults). Eighty-six percent of informal caregivers provide care to a relative, and 14% of them are caring for their own child.²

The purpose of home care is to maximize health and functioning in people with long-term needs so that they may remain in the community in the least restrictive environment. This includes providing support for families who care for them. The needs of patients and their caregivers in the home have increased as changes in ...