What is home health?
Home health or home health care means clinical and medical supervision provided to patients in their homes by skilled medical professionals. Home health care includes a wide variety of services as needed by the patient provided by licensed health care professionals such as physicians, registered nurses, physical therapists, speech-language pathologists, occupational therapists, dieticians, medical social workers, respiratory therapists, wound care specialists and certified home health aides. All members of a home health care team have important roles to play and come together to make and follow a specialized care plan for the patient. Home health care also includes non-medical care such as help with daily living activities by skilled home health aides and medical social services. These home health services are most often provided by medical professionals through home health agencies or hospice agencies and are usually prescribed by a doctor after hospitalization or injury as a part of their health care regimen.
Types of home health services
There is a limitless range of home health services a patient can receive. These services are provided by health care professions according to the individualized care plan determined by the primary medical care provider. These home health services include:
- Doctor care: A doctor might visit the patient’s home for diagnosis and treatment and may periodically check if the home health care needs are being met.
- Nursing care: Nursing care is the most common type of home health care and its type depends on the patient’s needs. A registered nurse sets up a plan of care for the patient in consultation with the patient’s primary doctor. Nursing care includes wound dressing, intravenous therapy, ostomy care, giving medication, pain control, and monitoring the general well-being of the patient.
- Physical, occupational, and speech therapy: There are some patients that need to relearn how to perform daily duties or need help in improving their speech after an illness or injury and require the therapist to assist them at their homes. Physical therapists put together a specialized plan of care for the patient to regain and strengthen the use of their muscles and joints. Occupation therapists can help patients with physical, developmental, social, and emotional disabilities to improve their performance of daily activities such as eating, bathing, dressing, etc. A speech therapist assists the patient by helping them regain and improve their ability to communicate.
- Medical social services: Medical social workers can provide many services for patients such as counseling and finding community resources to assist them in their recovery. If the patient’s condition is very complex and needs the coordination of several services then some social workers also act as the patient’s case manager.
- Home health aide services: Home health aides help patients with their simple personal needs including getting in and out of bed, bathing, grooming, basic household work, etc. Aides can also get specialized training to assist with more specialized medical procedures under the supervision of a nurse.
- Homemaker or basic assistance care: If the patient needs they can also get assistance from a homemaker i.e a person who will help with household chores and tasks such as cooking, laundry, getting groceries, etc.
- Companionship: Companionship is also important for the recovery of patients. This is especially true for patients who live alone and need a companion to provide comfort and supervision. Companions can be in the form of home health aides or volunteers and may perform household duties as well.
- Volunteer care: Community organizations provide volunteers that can give basic comforts to the patient by assisting them with personal care, transport, helping them with paperwork, and providing companionship and emotional support.
- Intravenous and nutritional support: Patients can get help from dieticians that can come to their homes and provide dietary assessments and guidance to make sure they follow the treatment plan.
- Lab tests and X-ray imaging: Some laboratory tests and urine tests that the patient needs can be performed in their home for the ease of the patient. Portable X-ray machines allow this service to be performed at the patient’s home by laboratory technicians.
- Pharmaceutical services: This service allows patients to get medicine and medical equipment delivered at their homes. Additionally, if required, the patient can also receive training on how to take medicine, use the equipment, and for intravenous therapy.
- Transportation: Transportation can be provided for patients who need it to go to and from the hospital for treatment, tests, or physical exams
- Food delivery: Many communities and agencies offer home-delivered meals to patients who are unable to cook for themselves at home.
Some other services provided by home health care agencies include wound care for surgical wounds or pressure sores, patient and caregiver education, and monitoring the health status of the patient.
How to get home health services
Home health care services are provided through licensed or certified home health agencies to a home or community-based setting and follow a written and individualized care plan formed by a licensed primary medical care provider. It is essential that home health services must be prescribed and performed by licensed medical professionals. Home health and community support service agencies must obtain licensure and certification by the Texas Health and Human Services in order to comply with the state and federal laws and regulations. Through these regulations, the HHS protects the citizens of Texas who are receiving these services. A limitation is that the provision of home health care is only for clients that are homebound and do not include nursing facilities or inpatient mental health/substance abuse facilities. It also excludes personal care and non-licensed home care providers.
The process usually begins when the primary health care provider deems home health services necessary for the patient and refers them to a home health agency. Then a preliminary assessment is conducted that decides which services are needed by the patient and the perceived barriers in the provision of services or medical care. The client will be contacted within 1-2 business days of referral and the services should begin at the time specified by the primary care provider. A comprehensive evaluation of the patient is also carried out which includes their health, psychosocial status, functional status, home environment, adherence to therapies, disease progression, symptom management, and prevention and the need for nursing services. A care plan designed by the primary medical care provider will be implemented by the home health agency which includes, current condition and needs of the patient and the types, quantity, and length of home health services needed. Care providers mostly update the plan of treatment at least every 60 days.
In Texas, Medicaid covers all home health services under its program. If the doctor deems nursing or therapy services essential for the patient’s care plan then Medicaid will cover the expenses. As the Medicaid funded home health services are related to a specific disease or condition, they are mostly offered for a short term and Medicaid reviews the patient’s need for home health care every 60 days. Individuals must meet both state and federal regulations to receive these services under Medicaid.
Who can benefit from this?
Due to the steady increase in the elderly population within the United States, many of whom cannot take care of themselves and have numerous health problems, an increasing number of people are opting for home health services. Another important reason for this is that medical care in hospitals and nursing homes is much more expensive when compared to home health services. Additionally, the patients can stay in the comfort of their homes where they are in a familiar environment and often surrounded by their families. Some family members might not be able to give the attention and care that these patients need due to several reasons such as if they work away from home or if the patient requires treatment that is beyond their expertise. In this case, the families may get relief from the physical and emotional stress that accompanies caregiving. Thus, home health care is usually a cheaper and more convenient option that is just as effective as care in a hospital or nursing facility. Home health care is useful for:
- Elderly patients recently discharged from a hospital, rehabilitation facility or nursing facility
- Patients who need monitoring after a recent change in their medication
- Patients that cannot safely travel to and from the hospital due to their health
- Seniors who need occupational or physical therapy to improve their overall physical state and ability to live independently
- Gray SL, Mahoney JE, Blough DK. Medication adherence in elderly patients receiving home health services following hospital discharge. Annals of Pharmacotherapy. 2001 May;35(5):539-45.
- Kenney G, Rajan S. Understanding dual enrollees’ use of Medicare home health services: the effects of differences in Medicaid home care programs. Medical Care. 2000 Jan 1;38(1):90-8.
- Welch HG, Wennberg DE, Welch WP. The use of Medicare home health care services. New England Journal of Medicine. 1996 Aug 1;335(5):324-9.
- Penrod JD, Kane RL, Finch MD, Kane RA. Effects of post-hospital Medicare home health and informal care on patient functional status. Health Services Research. 1998 Aug;33(3 Pt 1):513.