The Home Care Association of America reported that more than 8,000 people have turned 65 every day since 2011, and the anticipated population growth of seniors will be at nearly 72 million by 2025. Although generally healthier than seniors a century ago, they have chronic diseases which will worsen as they grow older. Among these seniors are nurses and other healthcare providers who will transition out of the workforce and will also require care, putting additional stress on the healthcare system.
The current healthcare system is tilted toward acute care and cannot accommodate these trends around aging of the population, which creates a big opportunity for care in the home, especially given the cost. Comparisons of the cost of care delivery in acute, skilled nursing/rehabilitation facilities, and the home all consistently point to the home as the lowest cost setting. The long-term solution to the challenge of caring for an increasing number of seniors with chronic disease is by going back to the setting of where healthcare started – in the home and community settings.
Today the likelihood that you know someone or you, yourself, will receive care in the home is high because of the rising cost of assisted living care. A 2014 Bankrate.com analysis found the average cost for a one-bedroom unit is $3,500 a month which is unaffordable for many. The preference for receiving care at home is well documented, such as an AARP survey of seniors with nearly 90percent wanting to remain in their home and their community as long as possible.
Home care has been around for more than a century. Home care is typically comprised of non-medical care (commonly referred to as private duty or home care) and skilled (commonly referred to as home health care). Private duty began in the early 1900s with families hiring a nurse to provide care for a patient during an illness, and started to decline around the 1950s as nurses left to work in hospitals.
Home care started as a solution for providing extra help to those needing assistance caring for the elderly, eventually leading to the creation of the services now known as home care, personal assisted services, and elder care. In the 1970s, a reinvented private duty system was established providing one-on-one care.
Home health care originated in the 1960s with its inclusion in the Older Americans Act as limited to medically necessary, intermittent skilled care for the homebound acutely ill following hospitalization and expanded over time to better accommodate patient needs. The changes in Medicare reimbursement in 1965 brought growth to the industry by covering home healthcare services and the use of skilled professionals to manage health conditions and complex diseases.
The Balanced Budget Act of 1997 severely curtailed this growth with the introduction of the Home Health Prospective Payment System (PPS). A large number of Medicare-certified agencies hit by slowing reimbursement and a greater administrative burden closed. Since that time there have been a cycle of growth and decline of home health agencies. Most recently, there has been a decline due to state moratoriums on licensing, pre-claim review and other regulation and reimbursement challenges.
Today home care is not just private duty, it provides a continuum of care by creating a bridge of care, across all levels of care. It is clear private duty and home healthcare are complimentary, providing quality skilled and non-medical care in the home setting for patients and their family at rates lower than other care settings. There are opportunities to reduce costs by refining reimbursement models to increase the options of care in the home, and significantly improve patients’ outcomes and impact their lives.
