Exactly what is Home Care for the Elderly?

THA ILAH Lady in Hammock

Exactly what is Home Care for the elderly?  Home Care’s emerging customer market is one of the nations biggest and most mature. Just don’t call it OLD. Silver, maybe, but not OLD. America’s Baby Boom generation-a massive wave of nearly 80 million Americans rapidly approaching 65 – doesn’t really take kindly to being labeled over the hill. Truth be told, they aren’t quite ready for Home Care yet. But, the Home Care industry is ready for them! Or at least they should be, because if some of the players aren’t quite ready, they sure better hurry up.

Besides not wanting to be called OLD, Boomers are unique from their “Greatest Generation parents” in their hopes, fears, and motivations. This influential generation will have a profound impact on nearly all of society’s institutions: Retirement, Work, Recreation, Marriage, Family, Health Care, Housing, Entitlements, and the Economy.

For example: Since Social Security established the “normal” retirement at 65, life expectancy for a 65-year-old has increased by over seven years and continues to climb. Boomers will take advantage of their “longevity bonus” and create an entirely new model of retirement, cycling between periods of work and leisure. What motivates Boomers to stay in the game? The healthful benefits of continued mental stimulation and challenge.

Boomers fear illness and the possibility of winding up in a nursing home more than they fear dying; actually three times more, according to surveys! They will refuse to spend their last years in the institutional-type settings where they visited their grandparents.

Look at some developing trends: cruise ships that take the place of retirement communities; “brain gyms” where you sharpen your wits with computer games. You have to agree-getting older will never be the same. William Novelli, Executive Director and CEO of AARP, reminds us: “Boomers want to live well, and they want to live comfortably, and they want to live in familiar surroundings.” Boomers want and will demand to Age-In-Place, wherever they call home. And Home Care will be how they do just that – age with dignity and independence…at home.

Okay, okay, you still don’t understand just what the “Health” Home Care is?

But how do you put your finger on just what in tarnation is home care? Naming that baby is no longer simple because of the new home care customer-the Boomer. Boomers will make home health care reinvent itself. Let’s just get to the bottom line: In-Home Health Care must be viewed as a combination of services delivered in the home, keeping people out of the hospital or nursing home.

For those familiar with the term “gestalt,” true in-home health care is a configuration/combination of services, so unified that “the whole is more than the sum of its parts.” Boomers will require a Home Care gestalt, a seamlessly integrated model of in-home health care. Delivering this new model will be challenging for the home care industry, having a long tradition of being three separate service lines.

The Home Care industry is old; its beginnings can be traced back to the 1880’s. Home Care has evolved over the past century into three basic types of care—Home Health, Private Pay, and Hospice. They have been defined and shaped by government regulations and licensure and by the variety of payors (Medicare, Medicaid, commercial and long-term care insurance or self-pay). Let’s take them one at a time.

Private Home Care aka “Private Duty / Private Pay”

This type of home care has been around since the industry began in the 1880’s. Private Home Care encompasses a wide variety of services and is the least regulated by state and federal governments. The services can be grouped into Personal Care Services or Companion Services. Both provide extended hours of care.

This continuous type of care is different from Home Health Care (described below), which is intermittent. It is only through the combination of this type of continuous personal care and intermittent skilled care that Aging-In-Place is possible. Personal Care Services provide a wide range of assistance with activities of daily living (ADLs), such as bathing, dressing, grooming, assisting with ambulation or transferring, toileting, feeding, and providing medication reminders.

Companion Services help with what professionals call instrumental activities of daily living (IADLs), such as shopping, meal preparation, making medical appointments, transportation, laundry, and companionship. An individualized flexible program of Personal Care and Companion Services is custom designed to enable Aging-In-Place. Services are often covered by long-term care insurance or can be paid for privately by any person, company, trust officer, or family member.

Home Health Care

While voluntary home care agencies had been providing services for over a century, Medicare’s 1965 enactment and certification accelerated the industry’s growth by covering home health care services for the elderly. These services were expanded to include certain disabled individuals in the 1973. This type of care looms large with over 17,000 providers nationwide serving 7.6 million people.

“But exactly what kind of Home Health Care services?” you might ask.

Well imagine you are recovering from an operation. You are disabled and too ill to take care of your¬self. Or, you have a condition which requires regular medical attention. Most would assume that they’d find themselves in a hospital or nursing home. However, with the assistance Home Health Care provides, a family can stay together in the comfort, security, and privacy of their own home while receiving these same hospital services. The care available through a certified home health agency generally includes those services which foster recovery, rehabilitation, recuperation, and health education provided by registered nurses, physical therapists, speech therapists, occupational therapists, certified nursing assistants, and social workers.

Home Health Care is a Medicare Part A benefit which requires no co-pay or deductible. Other payment sources may include: Medicaid, Blue Cross/Blue Shield, private insurance, and workers’ compensation. Some insurance policies will not cover all home health services unless certain conditions are met. If your insurance company does not cover the services you need, or you are uninsured, you may still obtain home health care through private pay or alternative funding sources. Most people don’t know that home health care is an excellent, efficient, and cost-effective alternative to hospital care or other types of institutional care. But now you do!


Hospice is a relative newcomer to the home care industry, having been first introduced in the United States in 1973. Ten years later, hospice was added as a Medicare benefit. Since then, the number of Medicare-certified hospices has grown from 31 in 1984 to over 3,000 currently. Hospice is a philosophy that affirms life and views dying as a natural process which can be met with dignity. Through Hospice care, people have the opportunity to make their own decisions about how and where they wish to live the remainder of their lives. Hospice focuses on enabling families to make choices about physical, emotional, and spiritual care during the final phase of life. Hospice offers emotional, social, and spiritual comfort and support. It allows the family to remain in their homes, should they so choose, living life to the fullest with a sense of quality, worth, and dignity.

Hospice’s philosophy contends that people are best served using an interdisciplinary team. The team includes physicians, nurses, social workers, home health aides, physical, occupational and speech therapists, nutritionists, pastoral counselors, and volunteers. Home visits are flexibly scheduled to meet ever changing needs.

As a Home Care service, Hospice may be reimbursable through Medicare, Medicaid, Blue Cross/Blue Shield, and private insurance. Some insurance policies may not cover Hospice services unless certain conditions are met. Again, if you do not have hospice coverage, you may still obtain services through alternative funding arrangements.

“When I’m 64”

That Beatle’s song underscores what Boomers are all about. You will not find aging Boomers sitting off at the margins of our society. You will, as Bill Novelli reminds us, find them “on rollerblades or on the Internet…inline and online-and mainline!” They have high expectations in life. Remember that “gestalt” term? The Home Care industry better get the “gestalt” and give Boomers the integrated in-home care model they demand as they age. The good news for Home Care is that helping people Age-In-Place will allow them to live healthier, safer, and happier lives. Including you and me!