"Home care" addresses both house calls made by physicians, nurse practitioners, and physician assistants, and care delivered by nurses and rehabilitation therapists working for home healthcare agencies.
Role of Health Care Professionals in Home Care
Your physician is usually the leader of an interdisciplinary healthcare team that may include nurses, therapists (such as: speech, physical, occupational, and respiratory therapists), social workers, personal care aides, home medical equipment suppliers, and most importantly, formal and informal caregivers (e.g., family members). Although all team members are important, the physician is legally responsible for working with you or someone you identify to determine your health care needs. Physicians also develop, certify, and recertify the plan of care.
House Call Services
House calls refer to visits to the home by physicians, nurse practitioners, and physician assistants to provide medical services. House calls can add to a healthcare provider’s knowledge of the circumstances and home setting of the older person. This may allow them to see and address problems that cannot be seen during an office visit. For example, there may be barriers that prevent an older person from functioning as well as they could, such as cluttered hallways or a home that has no railings when it should.
A house call may also reveal caregiver burnout, elder abuse, or the use of medications that may get in the way of managing or treating a disease. House calls also help older adults who may have difficulty getting around outside of the home because they do not have to travel to see the healthcare team.
Is Home Care Right for You?
Home care refers to services provided by nurses and rehabilitation therapists (physical/occupational/speech therapy) who are part of home healthcare agencies. You may benefit from home care if you are dealing with one or more of the following:
- You have trouble getting around (for example, after a hospital stay or an accident).
- You have wounds that need to be cleaned.
- You need injections or other treatments.
- You need to learn more about your medical condition(s) and how to monitor them (for example, checking your blood pressure or your blood sugar).
- You need help with bathing, dressing, and meal preparation.
- You need care and emotional support when in the final stages of an incurable disease.
Home care and house calls are needed for some patients for a limited amount of time, but others require house visits on an ongoing basis.
In order to qualify for Medicare coverage for home care, a person must be “confined to home.” Medicare describes confined to home as having a condition that makes it hard for you to leave home. You do not have to be bedridden to be considered “confined to the home.” You can still be considered “confined to the home” if you leave your home to see a healthcare professional, go to a religious service, or go on “occasional outings" (for example, a walk around the block, family reunion, or other events that do not take place on a regular basis).
For more details, take a look at the Centers for Medicaid and Medicare Services’ booklet on Medicare and Home Health Care.
Limitations of House Calls and Home Care
Most older adults prefer to remain in their own home. However, situations and conditions may come up that make care in an institution or facility more appropriate. For example, caregivers may not be available to adequately address the needs of the older person. Similarly, caregiver burnout and stress may prevent continued safe care for the older person in the home.
There are also some serious medical situations that require frequent testing, breathing treatments, or intravenous medications. In these cases, receiving care in an institution may be a better choice than house calls or home care. In some cases, the home setting itself may be a barrier to delivering care in the home. For example, home care may be a poor or risky option for an older person living in an unsafe neighborhood, for someone who has trouble with alcohol or drug use, or for a person who doesn’t have enough room for equipment or environmental modifications.
Finally, care in the home is not always the least expensive choice. Out-of-pocket costs may make ongoing home care unaffordable. Insurance is more likely to cover care that is given in a nursing facility or other institutional setting.
Home Assessment & Modification
People confined to the home often have health problems or disabilities in one or more areas of their health and functioning. A comprehensive geriatric assessment is particularly valuable in this situation. A comprehensive assessment can be used to figure out the older person’s initial level of health and functioning, monitor the course of their illness, and evaluate effects of their treatments. Also, assessment in the home has some important advantages over office-based assessment.
Advantages of Home Assessment
The healthcare provider can see how the patient functions in their actual home environment.
This helps the healthcare provider determine if the home is safe and appropriate for the patient’s particular abilities and disabilities, or if changes need to be made. For example, the healthcare provider can assess if the older adult can perform activities of daily living (ADLs), such as bathing or dressing. The provider can also evaluate the caregiver’s abilities to address the needs of the older person. Home assessment can also identify and address the caregiver’s needs for counseling, training, and/or support.
There are two types of changes (modifications) that can be made to make sure that the home is safer for the older adult.
Environmental modifications can be recommended to improve function. For example, an older adult’s quality of life and ability to function might be improved by using modifications such as a hand-held shower, a shower seat, bathtub grab-bars, or a bedside commode. Barriers to using wheelchairs and walkers (such as door sills) can be identified and removed. Chair lifts and outdoor ramps can be recommended to help older people manage stairs. The assessment might also include an occupational therapy consultation. This can be useful in identifying other personal care and assistive devices for performing activities of daily living (or ADLs) and housekeeping chores. A number of home safety checklists are also available to help with home assessment.
Assistive technology to improve home safety can also be an option. For example, necklace or wrist radio devices that allow the older person to call for help. There are also emergency response systems that require the older person to push a button by a certain time each day. If they do not push the button, it will trigger an emergency response or checkup phone call. Newer technologies can provide help in administering and tracking medications, monitoring and transmitting vital signs, and connecting older adults to healthcare providers through audio and visual telemedicine screens. Homes can be equipped with fully automated systems to adjust heating and lighting, to allow doors to be opened and closed with remote devices, and to monitor activity throughout the home.
Portable or mobile testing technology (home diagnostics), including x-rays and electrocardiograms (ECGs), are available in most areas. Hand-held laboratory devices are also becoming more common. These home diagnostics allow for a much more comprehensive medical evaluation to be done in the home.