Usually, home health care is indicated when patients need monitoring, adjustment of drugs, dressing changes, and limited physical therapy. Home health care is commonly used

• After hospital discharge (postacute care), although hospitalization is not a prerequisite, particularly for the elderly

Home health care can also be used for

• Patients with conditions that require many days of hospitalization each year (medically complex care)
• Medically stable patients with severe functional impairment (long-term care)

Home health care is being increasingly used to meet the demand for long-term care. Home health care, which can reduce nursing home placement of patients by 23%, is less expensive than institutional care when home health aide and skilled care visits are scheduled appropriately.

Home health care is provided by agencies, which vary in ownership, size, location, and services. Some are certified. To be certified, an agency must meet state licensing requirements and federal conditions for participation in Medicare. Such agencies provide skilled nursing care under the direction of referring physicians. Nurses provide services under the supervision of a physician, who consults with them as changes in care are needed. Caring for patients at home requires communication among health care practitioners to ensure that patients are maintaining function and are progressing as expected. The patients or caregivers need to promptly report changes in the patient's condition to nurses or physicians to ensure that patients are monitored appropriately.

Home health care may provide medical and nonmedical services (see Table 1: Provision of Care to the Elderly: Services That May Be Provided in Home Health Care).

Table 1
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Services That May Be Provided in Home Health Care Type Specific Services Medical Nursing Skilled professional and paraprofessional care Hospice and respite services Durable medical equipment (eg, commodes, wheelchairs, walkers) IV therapy Dialysis Parenteral and enteral nutrition Ventilator support Diagnostic procedures (eg, x-rays, ECG, blood tests) Nonmedical Personal care (eg, help with bathing, washing hair, using the toilet, and dressing) Housekeeping services Personal emergency response systems Alarm devices Security surveillance Food programs (eg, meals-on-wheels)

Reimbursement: Few patients with a serious, chronic disorder can afford full home care even though most would prefer to remain at home. Medicare covers some home care services for patients who are homebound, but it has certain requirements, which depend on the Medicare option chosen (see Funding Health Care for the Elderly: Medicare). Some private insurance companies cover some home health care services (eg, infusion services) for patients who are not homebound.

For patients' care to be reimbursed by a third party, physicians must certify that home care is required and, for Medicare, that patients meet Medicare requirements for home care. Medicare requires that home health care agencies tell patients which services are reimbursable. Home care services that are delivered are based on a detailed assessment (Outcome and Assessment Information Set [OASIS]) that is completed by a registered nurse or therapist when the patient is admitted to Medicare. Third-party payers are increasingly limiting personal services to control costs. Home health care agencies are directly reimbursed by Medicare, Medicaid, or private insurers.

Last full review/revision June 2009 by Mary Ann Anderson, PhD, RN

Content last modified February 2012