“Modestly” is a good descriptor for how Pennsylvania home health services have grown in recent years, according to RN and LPN employment statistics.
The same cannot be said of the U.S. Bureau of Labor Statistics projections for home health aides, which show it as one of the nation's fastest-growing jobs, with 69 percent growth predicted in the decade leading up to 2020.
The industry encompasses a spectrum of in-home medical care, also including physical therapy, occupational therapy, speech therapy and medical social services. Vicki Hoak, CEO of the Pennsylvania Homecare Association, said she "absolutely" sees increasing demand for in-home care.
One reason is cost, according to PHA communications director Jennifer Battista. The average weekly cost of nursing home care is about $1,550, whereas home health services average about $380 a week.
That differential helps explain why home health represents only about 4 percent of the Medicare budget, Hoak said. Currently, Medicare requires that home health be ordered by physicians only if they find that patients meet criteria that include being homebound and requiring a skilled service "for a brief and intermittent" time.
"One of the rules of Medicare was that, if I was providing you with Medicare home health services and I did not see improvement, I had to discharge you," Hoak said. She said "was" because Medicare recently reached a settlement on litigation challenging that policy, and she is hopeful that home care may be extended to chronically ill seniors who "just need a little bit of care to stay home."
Resident age also will likely boost the demand for home health here. Pennsylvania is one of the oldest states in the country, Hoak said, the onslaught of independence-treasuring baby boomers is pending, and many current nurses are approaching retirement age.
Also, she expects that the result of health care reform and the formation of accountable care organizations, which are reimbursed on outcomes instead of quantity, will be an emphasis on right-sized and person-centered care that will be right up home health's alley.
"Somehow we've got to encourage and help that client or patient manage their own health care and take responsibility, and we now realize that it's all about motivational counseling," Hoak said. "It goes back to that one-on-one health care delivery, which really dovetails with a nurse visiting your home."
Home health organizations come in a variety of forms. According to Hoak, the oldest are visiting nurse associations, some of which have been around for more than a century. The concept of home-based care became more popular in the 1960s, and today there's a mix of big franchises and small independent companies offering the services. Many hospitals have home health departments, she said, and some nursing homes do as well.
"Nursing home services are changing," Hoak said. "Ten to 15 years ago, once you went into a nursing home, you pretty much stayed there the rest of your life. Today, they're viewed really as a rehabilitation facility — perhaps you had a hip replacement and need some physical therapy before you go home. A lot of them have become very focused on rehab and short-term stays."
As with much of the rest of the health care industry these days, Hoak said, a great deal of acquisition is happening in home health. All providers must be licensed, and the Medicare website has a detailed search and assessment feature that allows comparison of them on the basis of medical standards and client reports.
Closely associated with home health is home care, which provides nonmedical services that are not covered by Medicare and is typically paid for by the consumer. Pennsylvania began requiring home care services to be licensed in 2006, and that industry is also seeing growth for many of the same reasons home health is.
"We often end up being contacted by home health providers," said John H. Gibbel, co-owner of the Lancaster location of the Home Instead Senior Care franchise. "Often while they're there or while they prepare to wrap up their services, they ask us to step in."
Home Instead also gets business from people in the independent-living branches of organizations that also offer personal or assisted-living care. Some of those organizations offer their own home care services, he said, but some have decided that they're better off not adding yet another division to their operations.
The Lancaster branch opened about eight years ago, Gibbel said, and he has been there for three years. It employs about 165 caregivers, and growth has been steady. Most of its work is privately paid, but it does work with the Lancaster County Office of Aging through some waiver programs.
Home health is medical care, including nursing and therapeutic services. It is typically paid for by Medicare and is usually short term, for those recovering from surgery or other health issues. There are nearly 500 home health agencies in Pennsylvania.
Home care is nonmedical and encompasses a variety of services, such as preparing meals, bathing, light housekeeping and transportation. Not covered by Medicare, it is usually paid for by the consumer. There are more than 1,500 home care agencies in Pennsylvania.