The United States census projects by 2030, the number of Americans older than 65 years old will have nearly doubled from 2010. The number of the oldest Americans – those 85 years old and older – are expected to double by 2036 and triple by 2049.
Along with the increasing numbers of Americans entering the Golden Years, Medicare enrollment numbers will naturally follow suit – doubling over the next 15 years bringing in a total of more than 80 million Medicare beneficiaries by 2030.
The Medicare population looks much different than it did years ago. Older Americans are healthier and living longer, but they have higher rates of obesity and diabetes. What’s also good to know is that the majority of people 65 years and older have at least one chronic condition – 25% of that population has four or more conditions.
Chronic conditions are what depletes the national healthcare expenditures. As people grow older and suffer from chronic conditions, offering effective and efficient care will be crucial.
Medicare Beneficiaries Prefer Home Care Services
Medicare beneficiaries are expected to engage with their care as they age. The U.S. healthcare system encourages and empowers patients to do so, as it helps mitigate the impact of chronic conditions.
In a survey by AARP in 2010, three quarters of respondents (over the age of 45 years old) “strongly agree” with the statement posed to them:
What I’d really like to do is stay in my current residence for as long as possible.
Dartmouth Atlas researchers asked patients if they “wish to avoid hospitalization and intensive care during the terminal phase of life”. Eighty percent of patients said they would, supporting the results of the AARP study.
Value-Based Programs to Meet the Healthcare Desires of Americans
To encourage health care providers to offer home-based services, the Centers for Medicare and Medicaid Services started value-based programs. These programs reward health care providers with monetary incentives based on the quality of care they provide to Medicare recipients.
Value-based programs aim to achieve the following goals:
- Improved care to individuals
- Improved health for the 65+ population
- Lower healthcare costs
The value-based programs sparked a home-based industry to provide health services.
Home Health Care
Home health care serves patients with medical treatment in the convenience and comfort of their home. This model lowers healthcare costs by 19% while increasing satisfaction for the patients.
Primary Care Services
A home care agency employs an interdisciplinary team of professionals including nurses, physicians, and other skilled home health professionals. These skilled home health professionals can provide services such as occupational therapy and physical therapy.
Approximately 3.4 million Medicare beneficiaries receive skilled home health care. Skilled nursing and therapy services are offered by home health agencies certified by Medicare. All services must be referred to by the treating physician.
Hospital Care Services
Hospital level care is possible with home health services. A “home hospital” provides acute care services much like inpatient hospitalization.
The benefits of home hospital care are:
- Reduces Costs
- Maintains Quality and Safety
- Improves Patient Experience
- Reduces Rehospitalization
The ability to provide home health care reduces hospital admissions and leads to more positive outcomes due to the absence of the stressors common with hospitalizations.
Who Qualifies for Home Health Care Services
It’s important to learn about who qualifies for home health care services, as it plays a role in Medicare coverage for the costs.
Medicare recipients who have Part A and/or Part B who also meet all of the following conditions may receive coverage for home health care services:
- The person must be homebound and the treating physician must certify it.
- The recipient has to be under the care of a physician.
- The physician has a plan of care for the patient.
- The plan of care is reviewed by the physician regularly.
The physician must certify the patient needs intermittent skilled nursing care beyond drawing blood and/or one of the following:
- Physical Therapy
- Speech-Language Pathology
- Occupational Therapy
These services are only covered if they are safe and effective in treating the condition being managed by the physician.
Services should be short term and effective. Medicare will only cover the amount or frequency that makes sense for treating the condition. Only a qualified therapist is allowed to provide the services and must show improvement in the condition for services to continue along with continued recommendation by the physician.
The home health agency providing in-home care must be Medicare-certified.
In-Home Health Care Services
In-home health care services vary depending on the patient’s needs and desires. Senior care can range from skilled care to light housekeeping and assistance with activities of daily living in the person’s own home. It can also include medical care, such as laboratory workups and EKGs.
In-home health care services are determined by the senior and treating physician. Caregivers are employed by a home health agency and may include:
- Licensed Practical Nurses
- Registered Nurses
- Therapists
- Physicians
- Home Health Aides
All home care providers have a background check performed to ensure they do not have a history of any acts that could put patients at risk.
In-home health care services are either paid for by health insurance or private pay by the person receiving the services or by a loved one.
Home care providers should have experience providing care to individuals with special needs, especially if providing care assistance to those with Alzheimer’s disease. Improving the quality of life for in-home care recipients is one of the most important goals.
In-home health care services are an alternative to nursing home care. It can be a long-term care solution if the person can afford to pay for it or if there is long-term care health insurance is active to cover the costs.
According to Medicare.gov, the Medicare program will only cover short-term in-home health care services. Once the person recovers from the condition or injury that led to the need for in-home health care services, a family member or family caregivers must take over or another solution must be implemented if the person needs assistance.
What Services Are Provided by Home Health Care
The services provided by home health care are:
✔️ Physician Care
A physician visits the patient at home to treat illnesses and conditions. The medical professional will also regularly assess the need for home health care.
✔️ Nursing Care
A registered nurse or licensed practical nurse will follow the recommendations of the physician and provide necessary care. Services may include:
- Intravenous Therapy
- Medication Administration
- Health Monitoring
- Paint Management
- Wound Care
- Osmotic Care
- Health Support
✔️ Physician Therapy – Occupational Therapy – Speech Therapy
Rehabilitation services can help patients relearn activities of daily living after suffering a disability due to an illness or injury:
This may include:
- Regaining Strength
- Relearning Walking
- Improving Communication
- Increasing Range of Motion
Speech therapists help people communicate better. Occupational therapists help people relearn how to take care of themselves. Physical therapists help people gain strength and mobility to be able to care for themselves with minimal physical limitations.
✔️ Social Services
Social workers provide counseling and case management to ensure seniors have all of the resources needed to remain healthy in their own home. They assess care needs and manage the medical services needed.
✔️ Home Health Aide Services
Home health aides help patients with their basic personal needs, such as:
- Getting out the bed, out of chairs or off the couch
- Walking to reduce the risk of falling
- Personal care such as bathing to ensure good hygiene
- Dressing for a higher quality of life
Some home health aides can perform other duties, such as medication monitoring, if they have received training and are supervised by skilled nurses.
✔️ Homemaker or Light Housekeeping
Living in a clean home and clothes and having healthy foods to eat are important to the quality of life for seniors. Home health care services can include homemaker and/or light housekeeping services, such as:
- Meal Preparation
- Laundry
- Grocery Shopping
- Cleaning the House
✔️ Companionship
Socialization is the most important factor in longevity, and caregivers provide that with their companionship. This service is especially important to seniors who are immunocompromised and aren’t able to spend much time out in public.
The COVID-19 pandemic has been incredibly difficult for seniors, as they have missed out on socialization by going to church, senior centers, and meeting with friends. Home health aides have made a difference in preventing seniors from becoming lonely and depressed.
✔️ Nutritional Support
The senior body needs nutrition to continue functioning optimally. Unfortunately, it can be difficult as appetite decreases, unsteadiness can make cooking dangerous, and memory loss can cause missed meals.
Home health care services can help people eat balanced meals that provide necessary nutrition on a daily basis. This may include a caregiver cooking, delivering meals, or setting up the delivery of meals each day.
✔️ X-Rays and Lab Work
Blood and urine tests can be performed in the comfort of the person’s home. This can be a great relief, as going to medical facilities can be stressful and risky being exposed to viruses.
In-home x-raying is possible with a portable x-ray machine. It can identify problems with muscles and joints, which can indicate a problem with internal organs. X-rays can show broken bones if a senior falls.
✔️ Transportation
Since many seniors cannot drive, home health care services offer transportation to run errands, go to medical appointments, and the grocery store.
✔️ Medication and Medical Equipment
Home health aides and nurses can deliver medications and medical equipment. This may include instruction on how to use the medical equipment or how to take medication correctly as recommended by the prescribing doctor.
Disadvantages of Home Health Care Services
It’s plain to see what the advantages of home health care services are, but what are the disadvantages of home health care services?
The disadvantages of home health care services include:
- Lack of Personal Care Services
People who receive in home health care services covered by Medicare are deemed homebound, which also means they are not able to move about freely. This also means they may not be able to clean their home, cook meals, go to the grocery store, etc. These services are not included in home health care services, which can disappointing to seniors.
- Limited Socialization
Since a senior receives health care services in the home and is homebound, socialization can be hard to come by. This can be depressing to seniors who are used to spending time with friends. The depression associated with being at home can worsen medical issues and delay recovery.
- Limited Time
Skilled nursing care is only available for a limited time. If a senior wants to continue a therapy, such as physical or occupational therapy, he/she will have to pay out-of-pocket.
- No Around the Clock Care
While a nursing home, skilled nursing facility, assisted living facility, etc. have staff available 24 hours a day, home health care does not. This can be dangerous if there is an emergency in the middle of the night.
- Frequent Provider Changes
Many times, home health agencies will send different health care providers because of availability. This can be distressing to seniors, especially those who are home alone and have a strangers providing their care.
While the above disadvantages can be discouraging, know that they are solved by supplementing the care provided by the skilled nursing care services. Adding personal care services, loved ones spending more time with their senior and having a caregiver can be great ways to offset the downsides of home health care.
Finding Home Health Care Services Near You
The industry for home health care has significantly grown over the last couple of years because of the demand for services. Agencies for home health care are opening almost every single day nationwide. Each agency is different in the services they offer and how they operate, which is why it is crucial to research home health care agencies near you.
Medicare recipients will need to make sure the home health care agency they choose is certified by Medicare. They also have to make sure they meet the criteria for Medicare coverage for home health care services. Contact us for help with your home health care agency search. We offer FREE senior care advising to all seniors and their loved ones, so they can make a well-informed decision when it comes to home health care.
This article was writen by Marcelina Hardy and was last updated on .
My name is Marcelina (Marcie) Hardy, and I’m a senior care advisor offering Medicare-approved home health care, nursing home, hospice, and long term hospital care options.