Home Care: An Overview

January 6, 2017 | Aging Services Risk, Quality, & Safety Guidance

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Budgetary pressures on payers and healthcare facilities, client preference, and the proliferation of technologies that can support care at home have made home care a fast-growing segment of healthcare. In 2014, 3.4 million Medicare beneficiaries received home health services, and more than 12,400 home health agencies participated in Medicare. As of 2014, the number of home health agencies had increased by 65% since 2004, and the total number of episodes of Medicare home care had increased by 60% since 2002. In 2013, 9% of fee-for-service beneficiaries used home care services, representing an increase of 26% compared with the year 2000. (MedPAC "Home Health Care Services") See Figure 1. Increase in Home Care Use, 2000 to 2013.

The exploding demand for services in individuals' homes is not limited to Medicare. States are expected to shift care out of nursing homes and into home- and community-based services (HCBS) as part of their efforts to contain the costs of rapidly expanding Medicaid programs, according to a 2016 report from the Kaiser Family Foundation. Kaiser notes that some states have been trying to shift care away from nursing homes in favor of home care for two decades, with nearly every state supporting increased waivers for HCBS in 2017. (Smith et al.)

However, as many established home care providers can attest, home care faces unique risk exposures. The environment of care is largely uncontrolled by staff and is not uniform. Homes are designed for living, not for the provision of healthcare, and home care is "superimposed on the 'everyday' circumstances of peoples' lives," as one expert writes (Lang). Clients typically have multiple conditions, often both acute and chronic, and self-care responsibilities.

This guidance article discusses the following risk management issues, but the list is not exhaustive:

Another core concern is risk management issues involving staff, which are discussed in the guidance article Home Care: Staff-Related Risks.

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