An Historical Perspective on Home Care Policy

Abstract

Although home care has received increased policy attention in recent years, the health services literature does not offer a historical perspective. The way home care is viewed and the nature of its support have changed significantly, yet history also suggests continuity. The era of modern medicine has relegated the status of home care to that of a residual set of follow-up services and there has been a lack of consensus about the goals of home care. For about 75 years, the legitimacy of home care has depended upon claims that it would relieve utilization and costs of institutional care, which has served both to maintain its policy salience and to undermine its legitimacy. Profound demographic and fiscal changes have increased the demand for home care, especially among the chronically ill, but various issues remain unresolved.

Compliance, satisfaction, and quality of life of patients with colorectal cancer receiving home chemotherapy or outpatient treatment: a randomised controlled trial

“…There is increasing interest in home care as an alternative to hospitalisation, particularly because of its potential for achieving cost savings by reducing levels of inpatient care 1. However, evidence for cost savings from home care has been limited to specific pathologies such as chronic obstructive pulmonary disease 2.…”

Home Health Care Reimbursement and the Supply of Therapy Services

“…11 Full PPS was implemented in 2000 and linked payments to beneficiary assignment to one of 80 home health resource groups (HHRGs), reflecting clinical, functional and service utilization factors and paid for a 60-day renewable episode of care based on the HHRG. 12 Between 2001 and 2010, the percentage of beneficiaries using HHC increased at a much lower rate, 3.9% annually or one-tenth of the rate in the earlier period, but spending continued to climb. 13 Given their sustained growth, the Affordable Care Act targeted HHC expenditures from several angle.…”

Long-Term Care in the United States: Policy Themes and Promising Practices

“…Benjamin (1993) proposed that the lack of consensus on the principles and goals of home care policy stems from the residual nature of these services, in that they are delivered to individuals who do not have the potential to benefit from other types of services. One could argue that the same problem plagues long-term care policy in general.…”