Home Care and Home Services

It is estimated that anywhere from 14 to 18 percent, or five to six million older adults living in the community could benefit from home care services. These numbers reflect those persons who are functionally impaired to varying degrees (that is, unable to perform one or more of their major activities of daily living such as cooking, shopping, cleaning, and dressing). Some of these older adults are totally confined to their homes and even their beds. It has been argued that additional numbers of older persons who now reside in nursing homes and similar such facilities could also be better served in their homes were in-home services more widely available.

Reflecting the current popularity of home care, the number of organizations providing in-home services to incapacitated persons has increased significantly in recent years. The home care service industry has grown from only eleven hundred such programs in 1965 to more than twenty thousand currently (National Association for Home Care, "Basic Statistics," March 2000). While a substantial proportion of patients served by home care programs are older adults, women in particular, it is important to remember that home care services are also provided to a wide variety of individuals in need of help, including those with chronic health conditions, terminal and acute illness, and those with permanent disabilities. Home care services are also provided by a broad array of organizations including hospitals, visiting nurse associations, hospices, Area Agencies on Aging, senior citizen centers, and even some nursing homes that have moved toward diversifying the services they offer older adults in the community. The fastest growing segments of home care have been hospital-based programs and those that operate for a profit and are unaffiliated with other agencies or organizations. Freestanding for-profit agencies comprise 41 percent of Medicare-certified home care programs, followed by hospital-based agencies, which represent 30 percent (National Association for Home Care, "Basic Statistics").

It should be noted that since 1997 there has actually been a decline in the number of Medicare-certified home health agencies due, at least in part, to changes in home health reimbursement regulations enacted as part of the Balanced Budget Act of 1997. Approximately 2,500 home care agencies ceased to operate between 1997 and 2000, and Medicare home care expenditures actually declined by 4 percent in 1998, making it the only segment of health care to experience a decline during that period (National Association for Home Care, "Report Confirms Medicare Cuts"). More restrictive Medicare reimbursement requirements continue to challenge the capacity of some programs to operate on sound financial footing. At the same time, home care personnel continue to be in short supply, especially home care aides, who occupy positions of relatively low status within the human services sector, as reflected by their limited career advancement opportunities and low salaries.