They say that “home is where the heart is,” but now, home is where healthcare is, too. In the United States, the home care industry serves about 8.6 million patients, including primary care, pre-acute care intervention, post-acute care services and hospice and palliative care. There are also more than one million home health and hospice employees serving these patients. Home healthcare services, one piece of the home care industry pie, is not just the fastest growing industry in healthcare, but it’s also the fastest growing of all industries4.
Home healthcare provides a comfortable and safe environment for patients, serves as a catalyst for better patient outcomes, and provides a significant cost savings opportunity for our government and the healthcare system at large. The U.S. saved as much as $25 billion in hospital costs in 2008 alone because of the growth of home care services over the previous decade1.
In this article we’ll explore what home healthcare is, why more patients want to receive care at home, and why home healthcare is cost effective and ultimately, vital for the future of healthcare.
What is home healthcare?
At a basic level, “home healthcare” means exactly what it sounds like medical care provided in a patient’s home. Traditionally, home healthcare has been thought to include only basic services such, as bathing or taking patients’ blood pressure. In actuality, home healthcare is very skilled and high-tech, and home healthcare professionals know how to provide care in a less controlled environment more than any other care setting3.
Home healthcare can include broad care given by skilled medical professionals, including skilled nursing care, physical therapy, occupational therapy and speech therapy. Home healthcare can also include skilled, non-medical care, such as medical social services or assistance with daily living from a highly qualified home health aide. As the Medicare program describes, home healthcare is unique as a care setting not only because the care is provided in the home, but the care itself is “usually less expensive, more convenient, and just as effective” as care given in a hospital or skilled nursing facility.
Home healthcare provides services in the home to treat illness or injury, and is just as effective as care provided in a hospital or skilled nursing facility. The scope of services provided under home health is wide, and can include5:
- Wound care for pressure sores or a surgical wound
- Patient and caregiver education
- Physical, occupational, and speech therapy
- Intravenous or nutrition therapy
- Monitoring serious illness and unstable health
The goals of home healthcare are to treat an illness or injury, to ensure patients regain independence, and to prevent readmissions. All care is overseen by a physician and, in fact, a doctor’s order is required to receive home healthcare. Once a patient is referred for home healthcare, the agency will schedule an appointment to discuss the patient’s needs and assess the care required. The home health agency will stay in close communication with the patient’s primary care doctor so that everyone is aligned with care plans and outcomes.
Just as the services provided by a home health agency vary, so do the tasks home health staff would perform while visiting a patient. Examples include5:
- Monitor eating and drinking
- Check blood pressure, temperature, heart rate and breathing
- Ensure all medications and treatments are being taken or performed correctly
- Asses pain levels
- Look for any safety concerns in the home
- Provide education so the patient is able to take care of themselves
- Coordinate care by frequently communicating with the patient, the patient’s doctor, and any other caregivers
Why is home healthcare gaining popularity?
For a moment, imagine yourself as a patient. If you had a choice, would you want to receive care at home, where you are the most comfortable and it’s most convenient? Or, would you want to be transferred to another care facility? The comforts of home are too attractive to deny and it’s for that reason that home care is the patient’s preferred setting.
To the healthcare industry, home healthcare is attractive because care provided in the home can be executed less expensively. Home healthcare is often considered a key step towards achieving optimal health outcomes for patients. Patients are more relaxed and receptive to care when they are treated at home. In the home health setting, the patient has more control over their care and environment, and so there tends to be less incidents and safety issues than in other care settings.
Home care interventions can improve quality of life and reduce hospitalizations because of chronic conditions or unfortunate events. In fact, the Joint Commission is working to improve home care interventions by including preventions of avoidable causes of hospital readmissions, such as medication errors and falls, in its Home Care National Patient Safety Goals. The promise of home healthcare to reduce medication errors and improve safety, quality and cost measures, coupled with the increasing number of older adults with chronic conditions points to an influx of patients moving towards the home setting (The Joint Commission, 2011). A reduction in readmissions leads to better patient outcomes, which leads to higher reimbursements for care providers. This is beneficial to not only the patient and the home health agency, but for the entire healthcare industry. Home healthcare is showing its value, and the industry is noticing.
Home healthcare and the future of healthcare
A Dobson|DaVanzo & Associates study from 2012 compared average monthly payments across settings, such as skilled nursing facilities, inpatient residential facilities and long-term care hospitals, and determined that home healthcare is the most cost-effective care setting for patients discharged from hospitals. The study analyzed the use of home healthcare throughout three years of Medicare claims data for post-acute care settings within 60 days of hospital discharge. Almost 40 percent of Medicare patients discharged from a hospital into a post-acute care setting use home healthcare. The study found that although home healthcare as a post-acute care “first setting” represented 38.7 percent of all Medicare episodes, it comprised just 27.8 percent of payments, shown as the “least costly” alternative2.
The overwhelming majority of funding for the home health industry comes from government programs, primarily Medicaid and Medicare at about $44.3 billion1, and there’s an immediate need to cut spending. One major issue currently faced by our healthcare system is the cost of hospital readmissions. Research published in the New England Journal of Medicine found that more than 2 million of hospitalized Medicare beneficiaries were readmitted to the hospital after 30 days throughout a one-year period. Unplanned return visits like these are associated with gaps in follow-up care and cost the government $17.4 billion. Gaps in follow-up care occur when a patient moves from a hospital or physician’s care to their home without proper preparation. Transitions of care is crucial to solve this problem and is a huge opportunity for home healthcare3.
Communication between all players in the healthcare continuum: hospitals, primary care, nursing homes, pharmacy, home care, laboratories, etc. is vital for improving patient outcomes, therefore reducing readmission rates. Accreditation programs and technology, such as electronic health records (EHR), can help optimize care coordination like never before.
As payment models shift from fee-for-service to bundled or Value-Based Purchasing models, home healthcare stands to be a “big winner”, as other providers see incentives to utilize home healthcare because it’s a lower-cost setting in post-acute care. Not to mention a demonstrated ability to reduce hospital readmissions and cut overall healthcare costs. Plus, home healthcare is the preferred care setting for patients because of its convenience and comfort factors.
In healthcare, there is a clear trend toward more personalized care with more patient choice. At the same time, the industry is geared toward achieving the “triple aim” of lower cost, better clinical outcomes, and higher patient satisfaction. While these shifts create much uncertainty in the future of healthcare, it is clear the system is moving toward a toward an expansion of home health services. This is a rare win-win for the healthcare system, taxpayers, and ultimately the patients under care.
1 Caring for America’s Seniors: The Value of Home Care. Retrieved from https://c.ymcdn.com/sites/homecareaoa.site-ym.com/resource/collection/1DC8DAAE-BF75-4CFD-8B7A-3FBA10864D54/Value_of_Home_Care___SECURED.pdf
2 Grace, A. (2012, May). Home Healthcare the Most Cost-Effective Post-Acute Care Setting. Alliance for Home Health Quality and Innovation. Retrieved from http://www.ahhqi.org/media-center/4
3 Home – The Best Place for Healthcare. (2011). The Joint Commission. Retrieved from http://www.jhartfound.org/images/uploads/resources/Home_Care_position_paper_4_5_111.pdf
4 Home Healthcare: Fastest-Growing Industry Faces Workforce Challenges. (2016). AMN Healthcare. Retrieved from http://www.amnhealthcare.com/home-health-industry-growth/
5 What’s home healthcare & what should I expect? Medicare.gov. Retrieved from https://www.medicare.gov/what-medicare-covers/home-health-care/home-health-care-what-is-it-what-to-expect.html