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Arranging for care received in the home is often confusing because it is divided into two distinctly separate systems. The first is professional skilled healthcare, which follows fairly rigid eligibility requirements and is billed to an insurance program. The other segment is paraprofessional support and personal care, available under funded programs or through individual payment. Which system is chosen is based upon the individual's immediate needs, medical condition, physical status, and living environment. Today's shorter hospital stays, limited family caregiving, outpatient surgeries, and longer lifespans have clearly created the need for both home care systems in the healthcare planning process.
The basic differences between skilled home healthcare and home care (personal care) are the professional levels of the personnel involved, the time spent with the patient, the services provided, and the methods of payment.
SKILLED HOME HEALTH CARE
Home healthcare is ordered by the physician or can be requested from the social service worker or discharge planner before the patient is discharged from the hospital. The home health agency arranges for a registered nurse, working with orders, to visit the patient at home to develop a plan of care for the medical condition and discuss the recovery expectations. The physician, patient, family, and home health agency team all participate in planning the care, treatment, and goal setting throughout the rehabilitation process. Examples of providers of this care are nurses, therapists, nutritionists, medical social workers, or certified home health aides who provide skilled care under the orders of a doctor and come and go on a regular basis to treat medical problems. These skilled practitioners also teach the caregivers and patient how to manage an illness or disability and confer regularly with the physician, reporting on the patient's condition, making changes in the care as needed, and accessing the other team services as they are needed.
HOME CARE (PERSONAL CARE)
Home care personnel are registered and practical nurses, homemakers, home health aides, and companions who stay with the patient for extended periods, providing personal care, housekeeping, cooking, and assisting with their ordinary daily activities.
They are paid
by the patient, private insurance policies, or locally funded
social service agencies.
This care is generally arranged by the patient and family, perhaps
through referrals by the hospital, social service worker, or physician.
Typically, a nurse visits the home with the prospective employee
to establish the schedule, plan the care program, and discuss
responsibilities and financial arrangements.
FINANCING SHORT-TERM AND LONG-TERM CARE
The costs of home
care can be evaluated only when separated into categories of (1)
long- and short-term duration and (2) into skilled or personal
care. Because the nature of long-term care is ongoing, it is often
difficult to find a single source of stable reimbursement for
an entire illness. Short-term care often is paid by insurers because
it is specific to a current medical episode and has a projected
duration. Planning and payment approval are usually arranged in
30- and 60-day segments.
The cost of skilled home healthcare is higher than personal homecare
because it is a state and federally regulated industry demanding
a sophisticated administrative structure. The homemaker-home Health
aide agencies are usually regulated under the same laws as employment
agencies and are able to keep their costs in a more affordable
range.
Almost all home
healthcare is paid for by insurers: Medicare, Medicaid, or health
insurance companies. In contrast, the majority of personal homecare
is fully or partially paid for by the user, unless the patient
meets the financial criteria for community services or has long-term
care insurance policies that include personal care.
Home healthcare is a rehabilitation program, designed to help
the patient regain the maximum independence possible, promote
recovery from an acute episode, and teach coping skills for lifestyle
changes. Combined with the ongoing personal homecare support component,
the patient today has the choice to recover at home, and remain
in that home by utilizing the growing resources now available.
DORIS DREYER HIRN