Home care (also referred to as domiciliary care, social care, or in-home care) is supportive care provided in the home. Care may be provided by licensed healthcare professionals who provide medical treatment needs or by professional caregivers who provide daily assistance to ensure the activities of daily living (ADLs) are met. In-home medical care is often and more accurately referred to as home health care or formal care. Often, the term home health care is used to distinguish it from non-medical care, custodial care, or private-duty care which refers to assistance and services provided by persons who are not nurses, doctors, or other licensed medical personnel. For terminally ill patients, home care may include hospice care. For patients recovering from surgery or illness, home care may include rehabilitative therapies.
Home health services help adults, seniors, and pediatric clients who are recovering after a hospital or facility stay, or need additional support to remain safely at home and avoid unnecessary hospitalization. These Medicare-certified services may include short-term nursing, rehabilitative, therapeutic, and assistive home health care. This care is provided by registered nurses (RNs), licensed practical nurses (LPN's), physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), home health aides (HHAs) and medical social workers (MSWs) as a limited number of up to one hour visits, addressed primarily through the Medicare Home Health benefit.
The largest segment of home care consists of licensed and unlicensed non-medical personnel, including caregivers who assist the individual. Care assistants may help the individual with daily tasks such as bathing, eating, cleaning the home and preparing meals. Caregivers work to support the needs of individuals who require such assistance. These services help the client to stay at home versus living in a facility. Non-medical home care is paid for by the individual or family. The term "private-duty" refers to the private pay nature of these relationships. Home care (non-medical) has traditionally been privately funded as opposed to home health care which is task-based and government or insurance funded.
These traditional differences in home care services are changing as the average age of the population has risen. Individuals typically desire to remain independent and use home care services to maintain their existing lifestyle. Government and Insurance providers are beginning to fund this level of care as an alternative to facility care. In-Home Care is often a lower cost solution to long-term care facilities.
Concept:
"Home care", "home health care" and "in-home care" are phrases that have been used interchangeably in the United States to mean any type of care - skilled or otherwise - given to a person in their own home. There is, however, a distinction made on a state-by-state basis according to how each state regulates the home care industry. In New York State, for example, "home health care" is used to describe medical services performed at home by a healthcare professional, whereas "home care" describes non-medical, private duty care. Other states do not make the same distinction, but the difference between the two must be accounted for when dealing with Medicare reimbursements.
Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home health care providers deliver services in the client's own home. These services may include some combination of professional health care services and life assistance services. Professional home health services may include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy. Home care services include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship. Home care is often an integral component of the post-hospitalization recovery process, especially during the initial weeks after discharge when the patient still requires some level of regular physical assistance.
- Activities of daily living (ADL) refers to activities, including bathing, dressing, transferring, using the toilet, eating, and walking, that reflect the patient's capacity for self-care.
- Instrumental activities of daily living (IADL) refers to daily tasks, including light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone, and managing money, that enables the patient to live independently in the community.
While there are differences in terms used in describing aspects of home care or home health care in the United States and other areas of the world, for the most part the descriptions are very similar.
Estimates for the U.S. indicate that most home care is informal, with families and friends providing a substantial amount of care. For formal care, the health care professionals most often involved are nurses followed by physical therapists and home care aides. Other health care providers include respiratory and occupational therapists, medical social workersand mental health workers. Home health care is generally paid for by Medicaid, Medicare, long term insurance, or paid with the patient's own resources.
Types of Services:
Home care services are available to individuals who require intermittent or part-time skilled nursing care and/or rehabilitation therapies.The typically services available under the designated term "home care" include nursing care, such as changing dressings, monitoring medications, providing basic daily activities like bathing, short term rehabilitation, occupational and speech therapy.Some home health providers also include non-medical homemaker services including meal preparation, shopping, transportation, and some specific household chores.
The types of services available for home care have expanded throughout the history of the United States health care system do to continuous modernization of medical technology, particularly in the 1980s.Prior to the expansion, specialty services like intravenous antibiotics, oncology therapy, hemodialysis, parenteral and enteral nutrition and ventilator care, were only available in the hospital setting.This newly available technology has proven cost effective and improves the quality of life, increasing independency and flexibility for patients.
Hospice care is a method of care that can be included in the home care realm, but is also available as in inpatient service. Hospice is a cluster of comprehensive services for the terminally ill with a medically determined life expectancy of 6 months or less. Whether hospice services are performed at home or in a medical facility, the emphasis of care are the same; pain and symptom management, which is referred to as palliation.
The available home care services are provided by mix of physicians, registered nurses, licensed vocational nurses, physical therapists, social workers, speech language pathologists, occupational therapists, dietitians, home care aides, homemaker and chore workers, companions and volunteers.
Research and program accreditation:
Lotus Shyu & Lee found that providing home nursing care is more suitable for patients rather than in-house nursing-home care for patients that are not seriously ill and who do not need the services after discharge from the hospital.Modin and Furhoff regard the roles of patients' doctors as more crucial than their nurses and care workers.However, from an epidemiological standpoint, the risks of some community acquired infections are higher from home nursing than from inpatient nursing home care. In regards to financial expenditure, home nursing care is more cost effective than inpatient nursing home care.The quality aspect of home nursing has been reviewed by Riccio.Christensen & Grönvall study the challenges and opportunities of providing communication technologies supporting the cooperation between home care workers and family members. Although they provide home care for older adults in cooperation, family members and care workers harbour diverging attitudes and values towards their joint efforts. This state of affairs is a challenge for the design of ICT for home care.
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