Home Care and Home Services

A steadily expanding array of services are now available to older individuals that experience a health or long-term disability and wish to be cared for at home. Accompanying our improved ability to miniaturize and make portable a variety of medical and communications technologies has been the continuous expansion in the range of high-tech medical care that can be provided in the home (Kaye and Davitt). Presently available home environmental and medical devices include: personal emergency response and auto-dialing and alarm systems signaling the need for help; in-home computers for self-instruction on taking medications and operating medical equipment; telehealth and telemedicine systems that allow patient health monitoring and assessment from remote locations; intravenous therapy equipment, including artificial nutrition and hydration; mechanical ventilation; and even robots able to assist the patient in performing certain basic activities of daily living.

There are several types of organizations providing home care services to the aged, some of which offer one type of service exclusively while others provide a variety of integrated services. Most home care services are available twenty-four hours a day, seven days a week throughout the year. The designation home health agency usually refers to a Medicare-certified service provider that complies with governmental requirements and is highly regulated. Such an organization may focus on the provision of nursing services while others may offer a broader range of care including physical and occupational therapy, social work, housekeeping, and durable medical equipment.

There are numerous home care services that offer exclusively homemakers and home health aides. Although not equipped to provide nursing services, the home health aides offer hands-on care such as patient bathing and dressing in addition to bearing responsibility for household tasks, including meal preparation and light housekeeping. Housekeeper services exclude hands-on care. Both home health aides and housekeepers serve as companions for their patients.

Hospice care, which may be offered as an in-patient service or in the home, is designed to provide integral medical, psychosocial, and spiritual care to the terminally ill as well as offer support to their families. It is typically available to persons with a life expectancy of no more than six months. Providers of hospice care in the home furnish the necessary services, equipment, and medications to allow the patient to die in his or her own home, in the company of loved ones, and without unnecessary pain. Care is palliative, alleviating pain without curing. Hospice services are typically Medicare certified.

In addition to home health care and hospice agencies, registries, specialized employment agencies, and private-duty agencies are sources for hiring home care workers, particularly nurses and aides. Unlike their Medicare-certified counterparts, they are not usually regulated or licensed by a government body and they do assess a fee for placement of staff. All types of home care personnel—nurses, aides, therapists, social workers, companions, and others—may be privately employed by individuals without a mediating organization. These home care workers, however, are not regulated by an outside party unless they receive government funding.

As a result of the trend toward providing in-home services to the more infirm, durable medical equipment suppliers, pharmaceutical companies, and infusion therapy companies have become regular features of the home care landscape. Providers of durable medical equipment offer a variety of products, including respirators, wheelchairs, catheters, and walkers, and typically provide delivery and set up. Some pharmaceutical, respiratory therapy, and infusion therapy companies provide nursing staff as well to administer medications and train patients in proper self-management techniques for the medical equipment provided.

Not only are home care services available in a number of forms, they are also provided by an array of professionals and paraprofessionals as described below.

• • Companions, as their name would suggest, provide companionship to home care patients who are socially isolated and, in doing so, also increase the patient's safety by visiting on a regular basis.
• • Dieticians who are trained in the nutritional needs of patient populations offer dietary assessments and counseling.
• • Home health aides assist patients who cannot manage their activities of daily living alone. They may provide help with toileting, dressing, meal preparation, and transferring as well as offer companionship to the isolated.
• • Housekeepers or homemakers offer chore services such as light housekeeping, laundering, and shopping. Unlike home health aides, they do not provide hands-on patient care.
• • Occupational therapists (OTs) help patients with their daily living activities by providing skills, specialized adaptive equipment, and retraining. They address tasks such as bathing, meal preparation, dressing, and household maintenance.
• • Physical therapists (PTs) work with patients to relieve pain or restore mobility through the use of exercise, massage, and specialized equipment.
• • Physicians, as independent professionals, may make visits to the home to diagnose and treat patients or they may provide these services as a member of a home care service interdisciplinary team. Physicians may also oversee patients' care plans and prescribe medications.
• • Registered nurses (RNs) and licensed practical nurses (LPNs) provide skilled services such as wound care, injections, and intravenous therapy that cannot be provided by paraprofessional and nonprofessional staff.
• • Social workers, who often serve as case managers in home care, tend to the emotional and social well-being of patients by providing counseling services and establishing relationships between patients and other types of needed service providers.
• • Speech therapists address the needs of patients with communication disorders that hinder their ability to speak. They are also qualified to provide assistance with muscle control in and around the mouth area that may affect breathing and swallowing.
• • Volunteers can play a critical role by offering a variety of services including friendly visiting, transportation service, meal delivery, and running errands.