Home care is one of the fastest growing segments of the health care delivery system. Much of the day-to-day home care responsibility, not borne by family members, is borne by social workers. In this responsibility social workers experience new and undocumented kinds of ethical concerns related to self-determination, barriers to service access, and areas related to assessment of mental competence. The home care worker is at the interface between helping and legal responsibility.

South Florida is at the forefront of home care trends in the United States. Statistics show the dependency level of people in home care in South Florida is increasing. Direct home care services are increasing. In the next 10 years, the number of older Floridians needing care is likely to increase by 40% or more. Among people 65 years old or older, nearly 70% are likely to need some kind of home care at some point.

The home care system has particular importance as the population ages and families spread out over the country reducing their availability as helpers. On the other hand the cost of home care has an impact on Medicare budgets that has caused some important reactions from government.

Since home care services are covered by Medicare, changes in the reimbursement system called the Prospective Payment System (PPS) are expected to have some impact on the way home care services are delivered. Under the old system payments to hospitals were made retro-actively on a fee-for-service basis. Under the new system payment amounts are fixed for treating people with particular diagnoses, regardless of the type of care offered. This payment system implies an incentive to keep treatment times short and lower costs of care.

A study by the Rand corporation and the University of California found that under the PPS system hospitals are more likely to discharge patients in an unstable condition. In effect, some of the hospital stay care responsibility has been transferred to home care.

Eligibility for Medicare home health is now limited to the “homebound” who need “intermittent” skilled nursing or therapy services as prescribed by a physician. Someone needing only “personal” care does not qualify. Once a beneficiary is deemed eligible, Medicare pays for unlimited visits for “part-time or intermittent care” from any of the official six home health care disciplines, with no co-payment or deductibles. These changes resulted in sharp drops in the use of home care visits related to health conditions.

Best Care, is a private, state licensed nurse registry with 35 years experience referring caregivers in South Florida. Please contact us to see how we can help.