Home Care and Home Services

The first documented home care program, the Boston Dispensary, was created in 1796. Boston University's Home Medical Service, founded in 1885, is considered to have been the first hospital-based home care program. Beginning in the 1920s, interest in home care was sparked by those directing attention to the treatment of the increasing number of chronically ill patients. While it was agreed that such patients were not best served in acute care hospitals, disagreement persisted through the 1930s and 1940s as to whether they were better served in institutional settings or in their homes.

More recently, the financial benefits accruing to home care have been emphasized. In the 1970s and early 1980s, proponents of home care argued that home-delivered services were a legitimate substitute for costly hospitalization and increased public money being spent on nursing home care. At the same time, expanded coverage of home care services was legislated through the Medicare and Medicaid systems, the primary government programs supporting this category of service. These regulatory changes, especially those under the federal Omnibus Budget Reconciliation Act of 1980 (OBRA), fueled the expanded use of home health care services. Hospice care for the terminally ill, also delivered in the home, was included in Medicare for the first time in 1982.

Throughout the 1980s, the number of proprietary or for-profit providers of home care grew at a particularly rapid pace because Medicare amendments under OBRA allowed such providers to be Medicare certified. It should be noted that although home care has grown considerably since 1980, it continues to represent a small proportion of spending for all personal health care costs (less that 10 percent of Medicare and Medicaid benefit expenditures are for home care services). The third most common source of payment for home care services is out-of-pocket payments by consumers themselves (Kaye, 1995, 1992).