Home Health Care Risk Management Part 1 – The Growth of Home Health Care
Home health care is defined as skilled nursing care and certain other health care services that you get in your home for the treatment of an illness or injury. At last count, there were 12,445 Medicare-certified home health agencies and 20,660 other home care companies in the United States. Indeed, home health care is the fastest growing sector in the industry serving those who require elderly health care. This is due to a number of reasons:
- The enactment of Medicare in 1965
- The 1987 revisions to Medicare, which introduced reimbursement to home care agencies
- The continual growth of our aging population
- The increased life expectancy of seniors
- The willingness to decrease the length of hospital stays and provide early discharge of many patients to home care
Classification of Home Care Agencies
Freestanding proprietary agencies provide most formal home care. Home care is also provided by hospital-based agencies, with nonprofit public and private health agencies providing a smaller portion. There are three major classifications of home health care agencies:
- Certified Home Health Agencies (CHHAs) – authorized to serve both Medicare and Medicaid recipients. Provide short-term skilled nursing care and aid with personal care, health needs, and some housekeeping.
- Long-term Home Health Care Programs (LTHHCPs) - also known as “nursing homes without walls” as they provide services usually provided by nursing homes and allow the elderly patient to remain at home. Provide case management and all the services provided by a CHHA.
- Licensed Home Care Services Agencies (LHCSAs) – provide one or more of the following services: nursing and/or personal care, private duty nursing, homemakers, health aides, and physical/occupational/speech therapies.
Employees in Home Health Care
Home health care employs over 2 million workers, primarily aids and personal assistants. Home health care aids provide basic medical services such as checking vital signs, changing dressings, and assisting with the use of medical equipment. They may also assist with bathing, grooming, and some light housekeeping. Personal assistants also referred to as “personal care workers” and “home care attendants,” primarily focus on assistance with daily living activities such as bathing, dressing, feeding, housekeeping, and transportation.
Patients in Home Health Care
To get Medicare home health care a patient must meet all four of the following conditions:
- The patient’s our doctor must decide that home medical care is necessary and provide a plan for at home care.
- The patient needs at least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech language pathology services.
- The patient must be homebound, which means normally unable to leave home. Being homebound means that leaving home is a major effort, and only occurs infrequently, for a short time, or to get medical care.
- The home health agency caring for the patient must be approved by the Medicare program.
A large proportion of home care patients have heart disease, followed by injuries, osteoarthritis, and respiratory problems. Also, as life expectancy increases and more patients enter home care, the complex medical problems and multiple diagnoses requires greater intensity of care.
Because the elderly population continues to grow, it is important to identify the risk factors that affect patient safety and health in home healthcare settings. In the next article in this series, we will examine some of those risk management issues.
At Highland Risk Services, we know the unique risk management issues related to home health care. Please contact us to get assistance planning services for your home health care clients. Call us at one of our two offices in Chicago at 847-832-9100 or Lansing at 517-676-7100.