The History of Elder Home Care Services

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posted by Suzie Schmitt on January 25, 2021

elder home care services

Reports from the U.S. Census Bureau reveal that in 2050, the number of people in the United States aged 65 and over will be almost 84 million. That estimate is almost twice as much as the 43 million projected in a 2012 report. Also, surviving baby boomers will be over 85 years old at this time. These projections highlight more than ever the need for caring persons to offer themselves for service in the home health care services industry, which currently stands at about 1.4 million employees.

According to the Home Health Care Association of America (HCAOA), over 70% of seniors as they get older will need assistance with daily living activities. That is a huge number of clients, which will only get larger, as the life expectancy of elderly adults has dramatically increased in recent years. The time to plan senior care management for these 84 million senior adults is now.

The Beginning of Home Health Care Services

It is not uncommon to discover that an older person never received medical care until they were gravely ill. That’s because it used to be much more common to use plant remedies and other natural substances to treat common illnesses. Family members and friends who claimed to know about various illnesses also helped care for the community’s senior citizens.

These community caregivers treated everything from broken bones, abrasions, and other injuries. Many of them did not have any formal medical training. They earned their medical skills by learning from other family members who passed the information on to them.

Community caregivers made house calls to visit the sick. Often, there were no funds to pay for health care. So, patients compensated medical caregivers through a system of bartering for other goods or services.

As much as we value our loved ones’ care, it’s hard to imagine that this type of elder home care services did not always exist. It was born out of a need when elderly citizens did not have family members to care for them. The federal government established the Social Security Administration, which later set aside funds for elder home care services and senior care management.

Philadelphia’s Visiting Nursing Society (VNS)

The history of senior care management in the United States closely aligns with the history of nursing. During the early twentieth century, there was no federally funded assistance available to help offset the cost of providing elder home health care services or care for the disabled. Most of the poor who needed care went to state “almshouses,” known for their poor conditions.

The social stigma attached to sending loved ones to one of these almshouses forced family members to do what they could to keep them home. Family members with the ability to pay for elder home care services hired individuals to provide private care for their loved ones in their homes. Some minority and immigrant communities set up organizations to help new immigrants and community elders instead of relying on public services.

Organizations like the nursing society in Philadelphia sent trained nurses into homes to care for the sick and poor and those infected with contagious diseases. They also provided care for pregnant women, instructed patients on better hygiene practices, and provided other health-related education.

As America entered World War I, VNS played a critical role in healthcare treatment and education. Over the years, as Philadelphia’s health care system became overwhelmed by influenza epidemics, poliomyelitis, and tuberculosis, VNS was there to provide interim health care to its citizens.

Home Care Services and Senior Care Management

When treating seriously ill patients, those involved in the medical profession had to determine who to give the most care to and how long they provided care, considering the available resources. Nurses provided initial health care to those acutely ill. They then turned the care over to their families once they were better. For those providing care, this was the most compassionate approach and the most cost-effective method.

At the end of the 19th century, healthcare at home continued to increase, and communities created more nursing organizations to meet the demand. Some argued that VNS nurses’ care received during home care visits was the preferred method of care over the more expensive hospitalization. The question of who would pay for the home health care services seems to always hover over the need to provide the necessary care.

Funds received from various donors help pay for the services, but it wasn’t enough. Because the demand was so great, organizations still had to establish a system for determining what patients would receive home health care and for how long. Caring for family members who were chronically ill remained the responsibility of the family. Patient advocates argued that the health care and senior care management system needed changing so that these patients could receive financing for more comprehensive health care.

The Role of Life Insurance in Home Health Care

Help for the Visiting Nurse Associations across the nation arrived in 1909 when a major life insurance company provided their policyholders with compensation for home nursing care. The insurance company’s reason for making the funds available was to help facilitate the treatment of those policyholders who had fallen ill so they could become well again. If those persons became well, it would extend their life span. Therefore, policyholders’ family members would file fewer death claims. By 1916, MLI provided insurance coverage to over 220,000 policyholders, who received over a million medical assistance visits.

Government and Home Health Care

One of society’s expectations was that families would take care of their sick and elderly loved ones. Therefore, policymakers only considered government assistance for home health care services to supplement persons who did not have family members to help them. They also provided funds to families who needed temporary assistance in caring for seriously ill loved ones just released from the hospital.

The Great Depression pushed more than half of senior citizens into poverty, overwhelmed the poorhouse system, and stirred public compassion for the old and people in need. In the 1930s, after the Great Depression, the New Deal promoted the idea that the elderly qualified for federal benefits based on need. President Franklin Delano Roosevelt signed the Social Security Act (SSA) into existence, which was not a universal benefit.

The needs of the patient determined whether the SSA paid for the services provided. It provided matched grants to each state for Old Age Assistance. Because of the stigma still attached to almshouses, they did not qualify for public assistance payments. Therefore, communities created more private nursing homes for elder home care services.

The Old Age Assistance Act

Financing for home health care services and elder home care services further evolved in the 1960s. That’s when the federal government added Medicare and Medicaid to the Old Age Assistance Act. With the Old Age Assistance Act’s passing, families could place their chronically sick family members into private nursing homes. The prevailing thought behind this change was that it would ultimately save money by emptying the hospital beds. Medicare provided only medically necessary, transitional skilled nursing care for those severely ill persons homebound after hospitalization.

Policymakers did not intend for Medicare to help with care for patients with chronic disabling illnesses. Therefore, the healthcare industry still needed a more cost-effective solution to provide for terminally ill persons who did not require full medical care.

The government’s funds provided health care services programs financed an array of elder home care services through community-based organizations. However, there was no adequate coordinated system of senior care management. Many patients did not know what home health care services they qualified for or how to access the funding to pay for those services. There were often gaps in the benefits created by poor senior care management when providers cared for patients at home.

In the late 1960s, a zealous response to Medicare forced the Department of Health to cancel most of the nursing homes coverage that the programs had initially allowed. Thousands had bills that were impossible to pay off.

In 1972, Public Law 92-603 contained several nursing home reform laws that provided reimbursement of services to nursing homes. Previously, with many states using random fee schedules, there was a considerable disparity in the cost of available health care and the levels of care. In 1985, a nursing home regulation reported initial legislation that further overhauled American nursing homes’ federal laws, standardizing care and funding.

Community Health Care Management

In the 1990s, various local, state, and national government agencies approved expanding home health care services. The new theme of healthcare reform was the consolidation of acute patient treatment and treatment programs based in the community. Organizations that manage health care and elder home care services attempted to coordinate the delivery of their services in many areas.

Finally, the health care community considered home health care to be a critical part of the patient’s required continued instead of a cost-savings alternative to institutional care. Policymakers learned a get through these experimental programs by delivering the services and providing various methods to finance them. However, they still could not create a universally accepted method of delivering coordinated community-based home health care services. New services conflicted with the standard medical practices and limited the choices patients had in choosing a provider. They also highlighted society’s ambiguity about providing elder home care services and supporting family caregivers.

The Balanced Budget Act (BBA) of 1997

Growth in the health care service industry halted abruptly with the provisions of this legislation. The passing of the BBA resulted in a $160 billion spending reduction between 1998 and 2002. The following are three areas provided for in the BBA to create savings in federal Medicaid:

  • Remove minimum payment standards from nursing homes, hospitals, and community health centers
  • Limit the federal matching payments to states for payments to disproportionate share hospitals (DSH)
  • Authorize states to avoid deductible payments and co-insurance for many low-income Medicare beneficiaries.

The result was that the BBA caused about 3000 health care services organizations to close their doors.

Modern Senior Care Management Options

The government introduced new payment systems for home health care services as a direct intense direct approach to the management of home health care. As with previous methods, this system promotes fewer hospital visits, provide skilled versus personal care, and transfer the continued care to the family as soon as possible.

While we profess to love our senior citizens, a debate continues as to whether the responsibility of caring for them rests primarily with the individual family or society. If a greater portion rests with society as a whole, the government should provide more monetary resources. Those funds will be a supplement to the patient’s private insurance policy and other funds raised by the family.

Family Home Care Management

Today, the responsibility of caring for elder home care services and caring for children and family members with disabilities rests with family members and friends. Despite the ambivalence in determining where the lion’s share of the responsibility lies, Home Health Care Agencies provide various services to care for elderly and sick family members. They help them with everything from daily life activities to transportation to and from doctor’s appointments. If you need assistance with 24-hour care, respite care, or for only a few hours a day, you can call on our professional, passionate health care team for help.

Current State of Senior Care Management

Elder health care services in America are continuing to evolve. The over 80-year-old age population is the fastest-growing age group in America. The home health care industry can expect to see many changes regarding senior care management in the future. Most seniors in the U.S. prefer to continue to live in their homes for as long as they can. However, studies conducted by Howard University show that the number of family members available to care for those seniors will decrease to less than 3.1% by the year 2050. Elder home care services will fill the gap left by family members. Because of the care given to the elderly, they are in better health and require fewer doctor and hospital visits. According to the HCAOA, senior care management and elder home care services are responsible for $25 billion in hospital savings.

Though services like Seniors Home Care, caregivers provide personal services that include personal care, medication management, home management, and other services. These services are provided to the client while in their home, wherever that might be.

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