1 Chapter 7. Home Health Care Long-Term Care: Managing Across the Continuum (Second Edition)

2 Learning Objectives 1.Define and describe home health care 2.Identify and define the components of home health care 3.Identify and describe regulations affecting home health care providers 4.Understand the financial, ethical, and managerial issues affecting home health care 5.Identify trends affecting home health care and the impact of those trends

3 Definitions Home Care: Supportive services Home Health Care: Skilled nursing and other health-related services Community-Based: Any service provided outside of a facility, including home care and home health care

4 How Home Health Care Developed Public health department visiting nurses Freestanding visiting nurse associations Growth based on better reimbursement

5 Philosophy of Care Takes services to the consumers’ homes Eligibility requirements (based on Medicare regs):  Physician-ordered  Intermittent  Homebound

6 Types of Home Health Care Home health agencies Hospice agencies Homemaker and home care aide agencies Staffing and private duty agencies

7 Ownership of Home Health Care Agencies Mix of nonprofit, for-profit, and government-owned Growing number are affiliated with other health care organizations:  Hospitals  SNFs  Rehabilitation facilities

8 Services Provided Nursing Therapies Dental care Laboratory Nutrition Care Mgt. Personal care Homemaking Transportation Education

9 Consumers of Home Health Care Largely elderly Some need on-going care Others need only temporary care following a hospital stay

10 Market Forces Consumer choice Cost-effectiveness

11 Regulations Medicare “Conditions of Participation” State licensure

12 Accreditation JCAHO CHAP ACHC

13 Financing Home Health Care Medicare - PPS Medicaid Other government programs Managed care Private insurance Self-pay and other sources

14 Staffing Combination of professional and non-professional staff Nurses Home Health Aides Therapists Social Workers Other specialists

15 Legal & Ethical Issues Patient noncompliance Patient Safety Fraud and reimbursement abuse Patients’ rights

16 Management Qualifications Not regularly licensed Medicare “Conditions of Participation” Certifications

17 Management Challenges & Opportunities Supervision of staff Staffing shortages Prospective payment

18 Significant Trends Technology Managed care Wellness programs

19 In Summary: Home health care has a long history, but has become increasingly attractive in recent years, and should continue to grow.