By Brenda Owen
When it comes to getting well, there’s no place like home.
And the medical profession has long recognized this fact. Home health agencies, home care aide organizations and hospices, known collectively as “home care agencies,” provide services to more than 7 million Americans annually because of acute illness, long-term health conditions, permanent disability or terminal illness. Annual expenditures exceeded $27 billion in 1995.
Established in the 1880s home health agencies numbered about 1,100 in 1963, but have grown to an astounding 17,000 currently, according to the National Association for Home Care (NAHC). Medicare enactment in 1965 greatly accelerated the industry’s growth making home health services, primarily skilled nursing and therapy of a curative or restorative nature, available to the elderly and, beginning in 1973, to certain disabled younger Americans.
Between 1967 and 1980, the number of agencies certified to participate in the Medicare program nearly doubled, from 1,753 to 2,924, according to NAHC. Between 1980 and 1985 the number of agencies nearly doubled again to 5,983.
In the mid-1980s, the number of Medicare-certified home health agencies leveled off at around 5,900 as a result of increasing Medicare paperwork and unreliable payment policies.
According to information provided by Margo Gillman of the NAHC, these problems led to a lawsuit brought against the Health Care Financing Administration in 1987 by a coalition of Congressmen, consumer groups and the National Association for Home Care. The successful conclusion of this lawsuit gave NAHC the opportunity to participate in a rewrite of the Medicare home health payment policies.
Since these revisions, Medicare’s annual home health benefit outlays have increased significantly and the number of home health agencies has risen to an all-time high of 8,747 as of August 1995.
Hospital-based and proprietary agencies have grown faster than any other type of certified agency since the coverage clarifications, according to the NAHC. Proprietary agencies now comprise more than a third, and hospital-based agencies equal nearly a third of all certified agencies.
Dr. Jeff Barber, president and chief executive officer at North Mississippi Medical Center in Tupelo, said in a recent press article that home care is one of the most efficient ways to reduce the cost of medical treatment and limit or even eliminate hospital stays. And home care provides a link between the patient and good quality medical care.
“Home health care is one of our fastest growing areas,” he said.
According to statistics provided by NMMC, the hospital’s home care visits have escalated from about 12,000 visits annually in the early 1980s to more than 350,000 visits last year.
National expenditures for personal health care totaled $900 billion in early 1994. Of this amount, nearly two-thirds was for hospital care and physicians’ services. Home care expenditures comprise only three percent of national health spending.
Home care is at the forefront of one of the health care industry’s most progressive new practices, “disease self management,” and is making a real difference in improving the health and lives of patients suffering from chronic or long-term diseases, said Tammie McCoy, a registered nurse with Tupelo-based Gilbert’s Home Health Agency.
For this reason, McCoy said, insurance companies are becoming more accustomed to home health care. Statistics from a 1995 NAHC report show the average charge per day for a hospital visit was $1,810 compared to an average cost of $86 per day for home care.
“If it is pre-authorized, most insurance companies are glad to pay the lesser cost of home care as opposed to a longer hospital stay,” she said. “The key to home care is you have to have someone willing to participate whether it is a family member who must learn how to provide care between visits or the patient themselves.”
The Mississippi State Department of Health has been state licensed and Medicare/Medicaid certified in every county since 1965 and the agency’s staff is expected to make approximately 300,000 visits statewide this year serving more than 3,500 individuals, according to Tucker Brown, director of operations for the Bureau of Home Health Central Office in Jackson.
Home visits have always been part of public health services, Brown said.
Dianne Hurd, supervisor of state home health services for District 11 which includes Northeast Mississippi said her staff made more than 41,000 home visits in 1995.
“Home care is a service to recovering, disabled or chronically ill individuals under the care of a physician who need medical treatment and/or assistance with activities of daily living. Our agency provides ‘charity care’ to those requiring Home Health services without a pay source. Uncompensated care typically requires more home care visits because they are more likely to be discharged from the hospital ‘quicker and sicker.'”
Hurd said home health care extends continued nursing and medical treatments from the hospital setting to the privacy and comfort of the patient’s home and the cost is lower than the hospital, nursing home or convalescent center.
“The patient is happier at home, and a sense of well-being contributes to recovery,” she said. “Home health is just part of comprehensive health care which patient sand the families might need to to Health Care Reform. It is anticipated by some, that home health will replace hospitals as primary health care providers in the next few years.”
Home health care has in its future much more than elderly health care, Hurd said.
“Home care will be utilized by individuals of all ages,” she said.