Midwives, healers, doctors, nurses and companions have been making house calls for centuries. Home health care is as natural and appropriate a solution to the challenges of coping with disease, injury and chronic illness as we can devise. So where did it go for all those years? And how is it that now, in the 21st century, it’s looking so good again?
Some background will help, here. In the 19th century, nearly all nurses worked in the home. For the most part, they helped new mothers and families and treated patients with infectious diseases. These visiting nurses were in great demand. Their services were even offered by Metropolitan Life to their policyholders in the first decade of the 20th century; the Red Cross, too, offered visiting nursing services to those in need in rural areas. After World War I, most local chapters of the Red Cross began to operate visiting nurse programs and the system quickly spread throughout the nation.
Then something interesting happened. By the early 1930’s, chronic degenerative diseases replaced infectious diseases as the leading cause of death in this country. People of all backgrounds began to seek hospital care, to the point that by the middle of the 20th century, so few patients were treated at home that home care became marginal. The rising costs of hospital care (along with campaigning by nursing organizations) brought home care back into favor in the 1960’s, and Medicare and Medicaid programs included provisions for home care. The National Home Care Association, founded in 1982, sought to act as the spokesman for the industry. They worked to provide quality care to home and hospice patients. And medical schools – about 80 percent of them – now offer specific training in home care.
This home care is, at present, provided by home health agencies, hospices, companies that specialize in medical equipment and supplies, and homemaker and home care aide agencies. Health agencies are usually Medicare-certified. Home care services generally involve a rotating team of specialists — doctors, nurses, companions, housekeepers, occupational or speech therapists, and medical social workers — and are available around the clock.
Yesterday, we reviewed the objectives and methods of a report issued by the US Department of Health and Human Services: Characteristics and Use of Home Health Care by Men and Women Aged 65 and Over. Again, this does not sound enticing, but give it a chance. If we are going to get control over our health care system, over our own health and well-being, we’ve got to understand what’s out there. We cannot pretend it doesn’t affect us: it does.
Increased life expectancy means we have a much bigger aging population in America than we’ve ever had before. And the aging population as a whole, along with the steady growth of its very oldest members, means we are moving from informal and short-term home care to more formal and long-term home health care. We aren’t just providing dad with a little efficiency apartment in the back now that mom’s gone and he can’t drive. We have care at home that offers a full range of medical and non-medical services, as well as therapeutic services. These services are delivered by a variety of health care professionals; costs and payment options vary widely.
- Female home health care patients (aged 65 and older) were more likely than male patients to be aged 85 and older. They were almost three times as liked to be widowed. Men receiving care at home were likely to be still married and receiving post-acute treatment.
- More than 80% of home health care patients aged 65 years and older had a primary caregiver outside of the home health care agency (males, 85% and females, 83%).
- Male home health care patients aged 65 and older who had a primary caregiver outside of the home health care agency were three times as likely as female patients to have their spouse as that primary caregiver. Women were about twice as likely as men to have a child or other nonspousal family member as their primary caregiver.
- Male home health care patients aged 65 and over were more likely than female patients to have had an inpatient stay immediately prior to receiving home health care.
- Compared with home health care male patients 65 years and over, females were more likely to have received home health care for 1 year or more and almost twice as likely to have Medicaid as their primary source of payment.
- Cancer was more prevalent among men; essential hypertension was more common among women.
If nothing else comes of this study, note this. No matter how much home health care is going on, no matter how many specialists, no matter how much visiting and consulting and treating, most primary caregivers are not professionals, strangers, outsiders or from agencies. These caregivers are us: daughters, sons, spouses. They will continue to be us. Just how are we going to do this for years on end? How will we pay for this, much less cope with the challenges to our faith and sanity? With grace and dignity, we hope. With support and resources, we hope. Still, it can be seriously overwhelming, really draining financially and emotionally, and, ultimately, thankless. And the problem really isn’t our aging parents or loved ones so much as it is a culture and leaders and employers who pretend this isn’t happening.
Special thanks US Department of Health and Human Resources.