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The home health care industry is an important component of health care systems that have the potential to lower the system-wide costs of delivering care, and free capacity in overcrowded acute care settings such as hospitals. Demand is doubling, but resources are scarce. A nursing shortage and near-zero profit margins hinder the ability of home care agencies to meet the increasing patient demand. The effective utilization of resources is vital to the continued availability of home care services. There is tremendous opportunity for the operations research community to address the challenges faced by home care agencies to improve their ability to meet as much patient demand as possible. This chapter describes tactical and operational planning problems arising in home health care, and discusses alternative configurations of home health supply chains. Formulations for home health nurse districting, home health nurse routing and scheduling, and home health supply chain problems are presented, and the relevant literature is reviewed. Recent developments in remote monitoring technologies that could change the home health care landscape are discussed, and future research directions are proposed.

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Home telehealth is a type of telemedicine technology that enables the collection and remote transmission of health data from a patient to a healthcare provider. It facilitates the ability for healthcare professionals to remotely monitor the health progress of patients, especially those with chronic illnesses, on a daily basis. By utilizing home telehealth, home healthcare agencies can provide better chronic care while reducing costs. Furthermore, the use of home telehealth has been shown to decrease the utilization of more acute care services such as hospitalizations and emergency department visits. Hence, a widespread adoption of HT technologies holds great potential for the current US healthcare system. In this study, a Bass diffusion model is used to understand the diffusion of home telehealth among home healthcare agencies in the US over time. The diffusion model is embedded within a system dynamics model to study how home telehealth will impact the long-term utilization of services in the US healthcare system. The potential benefits of home telehealth over a ten-year horizon are projected in a computational study. Results indicate significant cost savings in even the most conservative test instances studied.

Many home health agencies report low direct supply costs, but the total cost of the home health care supply chain may be much higher when indirect costs associated with ordering, storing, handling, and delivering supplies are considered. Results of a 2010 survey of home health agencies aimed at characterizing the home health care supply chain are presented, and statistical analysis is used to identify patterns based on agency affiliation, for profit status, and patient volume. Findings of interest to home health executives indicate the supply chain is performing well with respect to supply lead time and availability in patient homes. However, frequent practices reported may be leading to inefficiencies and high levels of nurse involvement in nonclinical duties such as ordering, sorting, and picking supplies.

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