Home care

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 care needs or by professional caregivers who provide daily care to help to ensure the activities of daily living (ADL's) 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 is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel.^[1]

Home Health services help adults and seniors 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), 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, primarily through the Medicare Home Health benefit.^[2]

The largest segment of Home Care consists of licensed and unlicensed non-medical personnel who assist the individual including caregivers^[3] and 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 individuals and this work helps them stay at home versus a facility. Often 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 has traditionally been privately funded as opposed to Home Health Care that is task based and government or insurance funded. These traditional differentiation in Home Care services are starting to change as the age worlds population has increased. Individuals typically desire to remain independent and use Home Care services to maintain their 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.

For terminally ill patients, home care may include hospice care. For patients recovering from surgery or illness, home care may include rehabilitative assistance.^[4]

United States

Professionals providing care

Professionals providing home care include licensed practical nurses, registered nurses, home health aides, physical therapists, occupational therapists and social workers. Rehabilitation services may be provided by physical therapists, occupational therapists, speech and language pathologists and dietitians.^{[citation needed]} Professionals can be independent practitioners, part of a larger organization, or as part of a franchise.

Home care aides, Certified Nursing Assistant (CNA's), and caregivers are trained to provide non-custodial or non-medical care, such as helping with dressing, bathing, getting in and out of bed, and using the toilet. They may also prepare meals, accompany to medical visits, grocery shop, and a number of other errands.^{[citation needed]}

Concept

"Home care", "home health care" and "in-home care" are phrases that are used interchangeably in the United States to mean any type of care given to a person in their own home. These phrases have been used in the past interchangeably regardless of whether the person required skilled care or not. More recently, there is a growing movement to distinguish between "home health care" meaning skilled nursing care (usually provided by a Home Health Agency) and "home care" (provided by Homecare Agency or independent home health aide or caregiver) meaning non-medical care.^{[citation needed]}

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 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 could include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy. Life assistance 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.^[5]

• 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 workers and mental health workers. Home health care is generally paid for by Medicaid, Medicare,long term insurance, or paid with the patient's own resources.

Aide worker qualifications

The state department of health issues requirement for that state. Workers can take an examination to become a state tested Certified Nursing Assistant (CNA). Other requirements in the U.S.A. often include a background check, drug testing, and general references.^[6]

Licensure and providers by state

California does not have licensure for non medical or custodial care services, and as such there are no entry requirements or minimum standards.

Full service agencies do preemployment background checks, including (criminal), department of motor vehicle, and reference checks. Full service agencies also train, monitor and supervise the staff that provide care to clients in their home.

There is a certification available for home care companies in California, administered by the California Association for Health Services at Home.^[7]

Florida is a licensure state which requires different levels of licensing depending upon the services provided. Companion assistance is provided by a home maker companion agency whereas nursing services and assistance with ADL's can be provided by a home health agency or nurse registry. The state licensing authority is the Florida Agency for Health Care Administration.^[8]

Compensation

Compensation varies according to discipline, but the Bureau of Labor Statistics estimates that the 2012 median hourly wage for home health aides was $10.01 per hour with the median annual wage of $20,820.^[9]

Supreme Court case relating to fees

For years, home care work has been selectively classified as a “companionship service” and exempted from federal overtime and minimum wage rules under the Fair Labor Standards Act (FLSA). The Supreme Court considered arguments on the companionship exemption, which stems from a case brought by a home care worker represented by counsel provided by SEIU. The original 2003 case, Evelyn Coke v. Long Island Care at Home, Ltd. and Maryann Osborne, argues that agency-employed home caregivers should be covered under overtime and minimum wage regulations.

Evelyn Coke, a home care worker employed by a home care agency that was not paying her overtime, sued the agency in 2003, alleging that the regulation construing the “companionship services” exemption to apply to agency employees and exempt them from the federal minimum wage and overtime law is inconsistent with the law.^[10] The Supreme Court heard the case in 2009.

In the court decision, the court stated the Fair Labor Standards Amendments of 1974 exempted from the minimum wage and maximum hours rules of the FSLA persons "employed in domestic service employment to provide companionship services for individuals ... unable to care for themselves." 29 U. S. C. §213(a)(15). The court found that the DOL's power to administer a congressionally created program necessarily requires the making of rules to fill any 'gap' left, implicitly or explicitly, by Congress, and when that agency fills that gap reasonably, it is binding. In this case, one of the gaps was whether to include workers paid by third parties in the exemption and the DOL has done that. Since the DOL has followed public notice procedure, and since there was gap left in the legislation, the DOL's regulation stands and home health care workers are not covered by either minimum wage or overtime pay requirements.

Department of Labor Ruling

A ruling from the Department of Labor, entitled "Application of the Fair Labor Standards Act to Domestic Service," and effective from January 1, 2015, "revise[s] the definition of 'companionship services' to clarify and narrow the duties that fall within the term; in addition third party employers, such as home care agencies, will not be able to claim either of the exemptions. The major effect of this Final Rule is that more domestic service workers will be protected by the FLSA’s minimum wage, overtime, and recordkeeping provisions."^[11]

Statistics on consumers

Payment

710,000 paid by Medicare - Medicare often is the primary billing source, if this is the primary carrier between two types of insurance (like between Medicare and Medicaid). Also, if a patient has Medicare and that patient has a "skilled need" requiring nursing visits, the patient's case is typically billed under Medicare.^{[citation needed]}

235,000 paid by private insurance, or self/family - Private insurance includes VA (Veterans Administration), some Railroad or Steelworkers health plans or other private insurance. "Self/family" indicates "private pay" status, when the patient or family pays 100% of all home care charges. Home care fees can be quite high; few patients & families can absorb these costs for a long period of time.^{[citation needed]}

The United Kingdom

Home care providers

Homecare is purchased by the service user directly from independent home care agencies or as part of the statutory responsibility of social services departments of local authorities who either provide care by their own employees or commission services from independent agencies. Care is usually provided once or twice a day with the aim of keeping frail or disabled people healthy and independent though can extend to full-time help by a live-in nurse or carer.

United Kingdom Homecare Association

The United Kingdom Homecare Association (UKHCA),^[12] is a professional association of 1,600 domiciliary care providers in the UK.^[13] The UKHCA maintains a list of agencies in their local area using a searchable list of home care providers in the UK.^[14][15] UKHCA produces Homecarer magazine,^[16] and provides a range of publications for homecare providers,^[17] such as Accessible Home Health Care^[18]

Statutory Regulation

Home care agencies are regulated by statutory bodies in three of the four home nations. The regulator's function is to ensure that home care agencies work within the applicable legislation:

England

• Regulator: The Care Quality Commission (CQC)
• The Health and Social Care Act 2008
• The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010

Wales

• Regulator: The Care and Social Services Inspectorate Wales (CSSIW)^[19]
• The Care Standards Act 2000^[20]
• The Domiciliary Care Agencies (Wales) Regulations 2004^[21]

Scotland

• Regulator: The Care Commission^[22]
• The Regulation of Care (Scotland) Act 2001^[23]

Northern Ireland

Legislation covering the homecare sector in Northern Ireland is not yet fully operational (as at December 2007).

Regulator: The Regulation and Quality Improvement Authority (RQIA)^[24]

• The Health and Personal Social Services (Quality, Improvement and Regulation)(Northern Ireland) Order 2003^[25]
• Domiciliary Care Agency Regulations (Northern Ireland) 2007^[26]

• Domiciliary Care Agencies National Minimum Standards (not published as at December 2007)

India

Professionals providing care

Even in countries like India there is a surge of professionals and organised companies providing home health care services.^[27][28]

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.^[29] Modin and Furhoff regard the roles of patients' doctors as more crucial than their nurses and care workers.^[30] However, from an epidemiological standpoint, the risks of some community acquired infections are higher from home nursing than from inpatient nursing home care.^[31] In regards to financial expenditure, home nursing care is more cost effective than inpatient nursing home care.^[32] The quality aspect of home nursing has been reviewed by Riccio.^[33] 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.^[34]

See also

• Caregiving and dementia
• Carers rights movement
• Early postnatal hospital discharge
• Elderly care
• Nursing home
• Personal care assistant
• Transgenerational design

Notes