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Home care

Home care

Overview
Home Care, is health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...

 or supportive care provided in the patient's
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....

 home
Home
A home is a place of residence or refuge. When it refers to a building, it is usually a place in which an individual or a family can rest and store personal property. Most modern-day households contain sanitary facilities and a means of preparing food. Animals have their own homes as well, either...

 by healthcare professionals (often referred to as home health care or formal care. Often, the term home care is used to distinguish non-medical care or custodial care, which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel, as opposed to home health care that is provided by licensed personnel.

In the United States, home care is also known as "skilled care," to distinguish from that given by family and friends (also known as caregivers, "primary caregiver", or "voluntary caregivers").

Professionals providing home care include: Licensed practical nurse
Licensed Practical Nurse
Licensed practical nurse is the term used in much of the United States and most Canadian provinces to refer to a nurse who cares for "people who are sick, injured, convalescent, or disabled under the direction of registered nurses and physicians. The term licensed vocational nurses is used in...

s, Registered nurse
Registered nurse
A registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...

s, Home Care Aids, and Social workers.
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Encyclopedia
Home Care, is health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...

 or supportive care provided in the patient's
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....

 home
Home
A home is a place of residence or refuge. When it refers to a building, it is usually a place in which an individual or a family can rest and store personal property. Most modern-day households contain sanitary facilities and a means of preparing food. Animals have their own homes as well, either...

 by healthcare professionals (often referred to as home health care or formal care. Often, the term home care is used to distinguish non-medical care or custodial care, which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel, as opposed to home health care that is provided by licensed personnel.

United States


In the United States, home care is also known as "skilled care," to distinguish from that given by family and friends (also known as caregivers, "primary caregiver", or "voluntary caregivers").

Professionals providing care


Professionals providing home care include: Licensed practical nurse
Licensed Practical Nurse
Licensed practical nurse is the term used in much of the United States and most Canadian provinces to refer to a nurse who cares for "people who are sick, injured, convalescent, or disabled under the direction of registered nurses and physicians. The term licensed vocational nurses is used in...

s, Registered nurse
Registered nurse
A registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...

s, Home Care Aids, and Social workers. Rehabilitation services are provided by: Physical therapists, Occupational therapist
Occupational therapist
An occupational therapist is trained in the practice of occupational therapy. The role of an occupational therapist is to work with a client to help them achieve a fulfilled and satisfied state in life through the use of "purposeful activity or interventions designed to achieve functional...

s, Speech and language pathologists and Dietitians.

Home care aides are trained to provide non-custodial care, such as helping with dressing, bathing, getting in and out of bed, and using the toilet. They may also prepare meals.

Concept


"Home care", "home health care" and "in-home care" are phrases that are used interchangeably in the United States to mean any type of care given to a person in their own home. Both phrases have been used in the past interchangeably regardless of whether the person requires skilled care or not. More recently, there is a growing movement to distinguish between "home health care" meaning skilled nursing care and "home care" meaning non-medical care. In the United Kingdom, "homecare" and "domiciliary care" are the preferred expressions.

Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home care providers render services in the client's own home. These services may include some combination of professional health care services and life assistance services. Professional home health services could include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy. Life assistance services include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship.
  • Activities of daily living
    Activities of daily living
    Activities of Daily Living is a term used in healthcare to refer to daily self-care activities within an individual's place of residence, in outdoor environments, or both...

    (ADL) refers to six activities: (bathing
    Bathing
    Bathing is the washing or cleansing of the body in a fluid, usually water or an aqueous solution. It may be practised for personal hygiene, religious ritual or therapeutic purposes or as a recreational activity....

    , dressing, transferring, using the toilet, eating, and walking) that reflect the patient's capacity for self-care.

  • Instrumental activities of daily living (IADL) refers to six daily tasks: (light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone, and managing money) that enables the patient to live independently in the community.


While there are differences in terms used in describing aspects of home care or home health care in the United States and other areas of the world, for the most part the descriptions are very similar.

Estimates for the U.S.
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 indicate that most home care is informal, with families and friends providing a substantial amount of care. For formal care, the health care professionals most often involved are nurses followed by physical therapist
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...

s and home care aides. Other health care providers include respiratory
Respiratory therapy
Respiratory therapy is a healthcare profession in which specialists work with patients suffering from either acute or chronic respiratory problems. These specialists are termed Respiratory Therapists in most places internationally but may also be referred to as Respiratory Scientists or...

 and occupational therapists
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...

, medical social workers and mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...

 workers. Home health care is generally paid for by Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...

, Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...

,long term insurance, or paid with the patient's own resources.

Aide worker qualifications


The state department of health issues requirement for that state. Often aide workers have experience in institutional care facilities prior to a home care agency. Workers can take an examination to become a state tested Certified Nursing Assistant (CNA). Other requirements in the U.S.A. often include a background check, drug testing, and general references.

Licensure and providers by state


California California is not a licensure state for non medical or custodial care services and therefore there are no barriers to entry, no consumer protection laws, no minimum standards yet and no official state oversight.
Full service agencies do preemployment background check (criminal), department of motor vehicle checks and reference checks. Full service agencies also train, monitor and supervise the staff that provide care to clients in their home.

There is a certification available for home care companies in California, administered by the California Association for Health Services at Home.

Florida is a licensure state which requires different levels of licensing depending upon the services provided. Companion assistance is provided by a home maker companion agency whereas nursing services and assistance with ADL's can be provided by a home health agency or nurse registry. The state licensing authority is the Florida Agency for Health Care Administration.

Payments and Fees


Live-in aides rates cost between $120–$200 per day for services. The rates are 20-30% higher for 2nd care recipient. Live-in aides are available through agencies as well as direct hire.

Agencies' fees for non-medical home care are traditionally not reimbursed by State, Federal, or private insurance. However, private long-term care insurance will often reimburse policyholders for part of the cost of non-medical home care, depending upon the terms of the policies.

Compensation


Registered nurses employed in the home care field receive on average around $22 to $30 per visit. Some as much as $45–$55, and also receive 45 to 58 cents per mile tax free. Payment/reimbursement of other Skilled Services vary according to the specific discipline.

Home Health Aides Caregivers working for state-licensed agencies bill at an hourly rate of about $11 to $25, depending on the state. A Home Health Aid employed by the agency is paid between $7.25 (current US minimum wage) and $10 or more per hour, depending on location. Home Health Aid employed by an agency can be paid up to $16-18 per hour.

Direct hire caregivers are either employed by family or are self employed. A direct hire home care aid is paid between $8 and $15 per hour depending on location, number of hours, and experience.

Supreme Court case relating to fees


For years, home care work has been selectively classified as a “companionship service” and exempted from federal overtime and minimum wage rules under the Fair Labor Standards Act (FLSA). The Supreme Court considered arguments on the companionship exemption, which stems from a case brought by a home care worker represented by counsel provided by SEIU. The original 2003 case, Evelyn Coke v. Long Island Care at Home, Ltd. and Maryann Osborne, argues that agency-employed home caregivers should be covered under overtime and minimum wage regulations.

Evelyn Coke, a home care worker employed by a home care agency that was not paying her overtime, sued the agency in 2003, alleging that the regulation construing the “companionship services” exemption to apply to agency employees and exempt them from the federal minimum wage and overtime law is inconsistent with the law. The Supreme Court heard the case in 2009.

In the court decision, the court stated the Fair Labor Standards Amendments of 1974 exempted from the minimum wage and maximum hours rules of the FSLA persons "employed in domestic service employment to provide companionship services for individuals . . . unable to care for themselves." 29 U. S. C. §213(a)(15). The court found that the DOL's power to administer a congressionally created program necessarily requires the making of rules to fill any 'gap' left, implicitly or explicitly, by Congress, and when that agency fills that gap reasonably, it is binding. In this case, one of the gaps was whether to include workers paid by third parties in the exemption and the DOL has done that. Since the DOL has followed public notice procedure, and since there was gap left in the legislation, the DOL's regulation stands and home health care workers are not covered by either minimum wage or overtime pay requirements.

Statistics on consumers


In February 2004, the National Center for Health Statistics
National Center for Health Statistics
National Center for Health Statistics is a division of the United States federal agency the Centers for Disease Control and Prevention . As such, NCHS is under the United States Department of Health and Human Services...

 (NCHS) conducted the "National Home and Hospice Study," which was updated in 2005.

The data was collected on about approximately 1.3+ million (1,355,300) persons receiving home care in the USA. Of that total, almost 30% (29.5% or 400,100 persons) were under 65 years of age, while the majority, almost 70%, were over 65 years old (70.5% or 955,200 persons).

The 2005 chart data of estimates based on interviews with non-institutionalized citizens, however, shows a relatively stable number of about 6 to 7 percent of adults age 65 who needed help for personal care (ADLs) - this has remained about the same between 1997 and 2004. (Data has a 95% reliability.) Those aged 85 or older were at least 6 times more likely (20.6%) to need ADL assistance than those of age 65. Between age 65 and 85 years, more women than men needed help.

To review the 2005 Early Release data used, visit the NCHS-NHIS website to see the PDF files. [NOTE: * The 2005 data reflects data, still between 6 to 7%, is only based on interviews conducted between January to June 2005, so it remains to be seen whether the figure remained constant or changed through the end of 2005.] Again, the 1998-2005 data is specific for over 65 or older and does not include any data for adults under 65 years old.

In the 2004 data, just over 30% (30.2% or 385,500) of the total 1.3+million persons lived alone, but the study did not break this down by age groups. A large portion, 1,094,900 or 80.8% had a primary caregiver, and almost 76% (75.9% or 831,100 lived with the primary caregiver, typically the spouse, child or child-in-law, other relative or parent, in that order. (Paid help and the category of neighbor/friend/ or unknown caregiver would be, for the majority, were living with non-family (4.3%) or unknown living arrangement .) Most patients still need external help, even if the primary caregiver is a spouse.

A total of 600,900 persons received personal care.

Payment


The study describes the population break-down by type of payment used. Of the 1.3+ million:

710,000 paid by Medicare - Medicare often is the primary billing source, if this is the primary carrier between two types of insurance (like between Medicare and Medicaid). Also, if a patient has Medicare and that patient has a "skilled need" requiring nursing visits, the patient's case is typically billed under Medicare.

277,000 paid by Medicaid.-

235,000 paid by private insurance, or self/family - Private insurance includes VA (Veterans Administration), some Railroad or Steelworkers health plans or other private insurance. "Self/family" indicates "private pay" status, when the patient or family pays 100% of all home care charges. Home care fees can be quite high; few patients & families can absorb these costs for a long period of time.

133,200 all other payments - including patients unable to pay, or who had no charge for care, or those whose payment "source not yet determined or approved." Sometimes after "opening a case" (the formal paperwork process of admitting a patient to home care services, there can be a short period of time when the office has not yet received approval by one of two or more insurances held by the patient. This is not unusual. There can also be cases where the office must make phone calls to be sure a particular diagnosis is "covered" by the patient's primary insurance. This is not unusual. These delays explain, in part, a couple circumstances where payment source would be listed as "unknown."

Home care providers


Homecare is purchased by the service user directly from independent home care agencies or as part of the statutory responsibility of social services departments of local authorities who either provide care by their own employees or commission services from independent agencies. Care is usually provided once or twice a day with the aim of keeping frail or disabled people healthy and independent though can extend to full-time help by a live-in nurse or carer.

United Kingdom Homecare Association (UKHCA)


Domiciliary care providers in the UK are able to join the United Kingdom Homecare Association, which is the professional association of domiciliary care providers in the independent, voluntary and statutory sectors. The Association represents the views of over 1,600 home care providers, each of which agrees to abide by the UKHCA Code of Practice.

UKHCA is often a point of contact for members of the public who wish to contact agencies in their local area using a searchable list of home care providers in the UK., Their leaflet Choosing care in your Home is a straight-forward explanation of what home care is and how members of the public can select the best provider for their needs.

UKHCA produces Homecarer magazine, a bi-monthly digest of the latest news and analysis of the domiciliary care sector, and a range of publications for homecare providers, many of which are available to the public, such as Accessible Home Health Care
Accessible Home Health Care
Accessible Home Health Care is a "personal health care" provider specializing in medical and non-medical services to all age groups from newborns to seniors. Headquartered in Coral Springs, Florida, they currently have 85+ units independently owned and operated....


Statutory Regulation


Home care agencies are regulated by statutory bodies in three of the four home nations. The regulator's function is to ensure that home care agencies work within the applicable legislation:

England


Wales

  • Regulator: The Care and Social Services Inspectorate Wales (CSSIW)
  • The Care Standards Act 2000
  • The Domiciliary Care Agencies (Wales) Regulations 2004

Northern Ireland


Legislation covering the homecare sector in Northern Ireland is not yet fully operational (as at December 2007).

Regulator: The Regulation and Quality Improvement Authority (RQIA)
  • The Health and Personal Social Services (Quality, Improvement and Regulation)(Northern Ireland) Order 2003
  • Domiciliary Care Agency Regulations (Northern Ireland) 2007

  • Domiciliary Care Agencies National Minimum Standards (not published as at December 2007)

Research and program accreditation


Lotus Shyu & Lee found that by comparing with nursing home services, home nursing is more suitable for the patients who are not seriously ill and who do not need the services of after-hospital discharging. Modin and Furhoff regard the roles of patient's doctors are more crucial than their nurses and care workers. However from epidemiological view, the risks of some community acquired infections are more higher from home nursing than from nursing home
Nursing home
A nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...

. In regards to financial expenditure, the home nursing is more cost effective than nursing home
Nursing home
A nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...

. The quality aspect of home nursing has been reviewed by Riccio.

See also

  • Caregiving and dementia
    Caregiving and dementia
    As populations age, caregiving and dementia become more common aspects of life. In most mild to medium cases of dementia the primary caregiver is a family member, usually a spouse or adult child...

  • Carers rights movement
    Carers rights movement
    The Carers rights movement attempts to address the issues of low income, social exclusion, damage to mental and physical health and lack of recognition that have been identified by research articles and studies of unpaid carers...

  • Early postnatal hospital discharge
    Early postnatal hospital discharge
    A definition that has been used for early discharge from hospital after childbirth is discharge of mother and baby within 48 hours of the birth....

  • Elderly care
    Elderly care
    Elderly care or simply eldercare is the fulfillment of the special needs and requirements that are unique to senior citizens. This broad term encompasses such services as assisted living, adult day care, long term care, nursing homes, hospice care, and In-Home care.-Cultural and geographic...

  • Nursing home
    Nursing home
    A nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...

  • Personal care assistant
    Personal Care Assistant
    A Personal Care Assistant - variously known under alternate names such as caregiver, personal care attendant, patient care assistant, personal support worker and home care aide - is a paid, employed person who helps persons who are disabled or chronically ill with their activities of daily living ...


External links