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How we work. Strategic partnerships. What we do. Young people. The site is secure. Department of Health and Human Services. This report was prepared under contract between the U. The e-mail address is: webmaster. Publicly-funded home care for the elderly involves both Federal, state, and local responsibilities. The primary responsibility for home care service delivery and quality assessment, however, lies with the states.
The purpose of this study is to gather information about current state activities to ensure quality in publicly-funded home care programs for the elderly. This report describes the activities of 19 states to address quality assurance in home care; compares and contrasts the range of quality assurance mechanisms currently in place in these states; and presents the perspectives of a variety of state officials on home care quality issues.
More than individuals in state and local programs in 19 states participated in the study. The report is based on telephone and on-site discussions and the review of state documents provided to the study team. It is a descriptive report based on state-provided information and is not intended to be an evaluation or assessment of those programs. In general, "home care" may be broadly defined to include all services provided in a client's home, ranging from skilled nursing care to chore services.
For purpose of this report two categories of home care are defined--home health care and supportive care. Home health care generally includes those services provided through the Medicare and Medicaid home health benefits and delivered by registered nurses; licensed practical nurses; home health aides; speech, occupational, physical, and other therapists.
Supportive care includes all other care provided in the home. The rapid growth of the elderly population needing some type of long-term care has been accompanied by a dramatic expansion of in-home and community-based services.
Home care programs are now providing an increasing variety of skilled and nonskilled health and supportive services to large numbers of people with chronic illnesses and impairments. Also accompanying this growth in the availability of home care is a rising concern about how to assure that consumers receive high-quality services.
Congress addressed home care quality issues in a number of bills introduced during and These bills proposed specific quality assurance mechanisms, uniform standards of care, and Federal regulation.
Additionally, in , Congress enacted changes to the Medicare program which included a patients' bill of rights and competency testing for home health aides as means of improving the quality of home care funded by that program. Federal home care funding agencies as well as nongovernmental agencies and organizations are also addressing home care quality issues through research efforts, national conferences, and accreditation and certification programs. Standards for providers.
Standards are the criteria against which programs assess quality. The most frequently reported standards for home care providers pertain to worker training, worker certification, licensing, and provider approval.
For example:. Worker training, the most common standard, ranges from simple worker orientation to highly developed training courses. While home health programs tend to have more rigorous training requirements, some supportive care programs also have highly developed standards for training homemakers and personal care aides. Worker certification is required by a number of state programs and is usually tied to training requirements for home health aides or personal care attendants.
Very few supportive care programs have worker certification standards. Four-fifths of the study states license home health agencies, and there is little variation in approaches to licensure. By-and-large, state licensing requirements mirror the Medicare Conditions of Participation. Some programs require providers to be state- or program-approved. Provider approval is more common for supportive care providers who are not regulated by licensure.
A number of other standards for home care, such as bills of client rights, accreditation, codes of ethics, and criminal record checks, are used less frequently. Monitoring of home care. Monitoring is the act of checking that standards are met. States employ several mechanisms to monitor the quality of home care in both home health and supportive care programs.
Commonly reported monitoring mechanisms include supervision of workers, supervisory home-visits, client assessments and evaluations, care planning, case management, contract reviews, and provider surveys:. Worker supervision is almost universally required, but the specific requirements for supervision vary considerably.
Medicaid home health program requirements are the most consistent, largely because Medicaid follows the Medicare Conditions of Participation. A few supportive care programs pattern supervision requirements after home health programs. Supervisory home-visits, required by all home health programs, are also used by many supportive care programs.
The nature and frequency of these visits range considerably. Client assessments and evaluations, present in almost all home care programs, differ in the method and frequency of assessments.
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