Care in the home is usually provided by family members, friends, or both. If needed, health care practitioners, such as visiting nurses, therapists, and home health aides, may come to the home to provide additional care. Home care is often coordinated by a community health agency after a period of acute hospitalization. Medicare provides time-limited coverage for services that are classified as skilled, such as wound care or the monitoring of active illnesses such as heart failure or diabetes. When people no longer need skilled care, they are usually responsible for the costs of any further nursing care. Long-term care insurance or Medicaid (for people who qualify) may cover home care services. Veterans may also qualify for home care services depending on their needs and disability rating.
Sometimes the primary care doctor coordinates a team of health care practitioners who work together to provide better care for people living at home with a chronic disorder or disability. This arrangment is called a patient-centered home.
The program for all-inclusive care for the elderly (PACE) is a benefit provided under Medicare and Medicaid (see Health Care Coverage for Older People: PACE Program). This program is available (only in certain areas of the United States) to people who are at least 55 years old and who meet their state's standards for requiring care in a nursing home. Services provided by the PACE program allow nearly all participants to live at home, although nursing home care is provided if needed.
PACE involves an interdisciplinary team including doctors, nurses, physical and occupational therapists, social workers, dieticians, and drivers. The services are typically provided in an adult day health center and are available every day. The program provides transportation to the center. Some services may be provided in the home.
The Department of Health and Human Services web site explains PACE and provides an up-to-date list of participating health care practitioners. See the Medicare website.
Last full review/revision February 2009 by Paul R. Katz, MD