Chapter 13. Patient Safety and Quality in Home Health Care

Home health care is a system of care provided by skilled practitioners to patients in their homes under the direction of a physician. Home health care services include nursing care; physical, occupational, and speech-language therapy; and medical social services. The goals of home health care services are to help individuals to improve function and live with greater independence; to promote the client’s optimal level of well-being; and to assist the patient to remain at home, avoiding hospitalization or admission to long-term care institutions. Physicians may refer patients for home health care services, or the services may be requested by family members or patients. The Centers for Medicare and Medicaid Services (CMS) estimates that 8,090 home health care agencies in the United States provide care for more than 2.4 million elderly and disabled people annually. To be eligible for Medicare reimbursement, home health care services must be deemed medically necessary by a physician and provided to a home-bound patient. In addition, the care must be provided on an intermittent and noncontinuous basis. Medicare beneficiaries who are in poor health, have low incomes, and are 85 years of age or older have relatively high rates of home health care use. Common diagnoses among home health care patients include circulatory disease (31 percent of patients), heart disease (16 percent), injury and poisoning (15.9 percent), musculoskeletal and connective tissue disease (14.1 percent), and respiratory disease (11.6 percent).