Professional Documents
Culture Documents
United States: Professionals Providing Care
United States: Professionals Providing Care
In the United States, home care is also known as "skilled care," to distinguish from that given by family and friends (also known as caregivers, "primary caregiver", or "voluntary caregivers").[citation needed]
[edit] Concept
"Home care", "home health care" and "in-home care" are phrases that are used interchangeably in the United States to mean any type of care given to a person in their own home. Both phrases have been used in the past interchangeably regardless of whether the person requires skilled care or not. More recently, there is a growing movement to distinguish between "home health care" meaning skilled nursing care and "home care" meaning nonmedical care. In the United Kingdom, "homecare" and "domiciliary care" are the preferred expressions. Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home care providers render services in the client's own home. These services may include some combination of professional health care services and life assistance services. Professional home health services could include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy. Life assistance services include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship.
Activities of daily living (ADL) refers to six activities: (bathing, dressing, transferring, using the toilet, eating, and walking) that reflect the patient's capacity for self-care. Instrumental activities of daily living (IADL) refers to six daily tasks: (light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone, and managing money) that enables the patient to live independently in the community.
While there are differences in terms used in describing aspects of home care or home health care in the United States and other areas of the world, for the most part the descriptions are very similar.
"The Woman as Family Doctor", by Dr. Anna Fischer-Dckelmann Estimates for the U.S. indicate that most home care is informal, with families and friends providing a substantial amount of care. For formal care, the health care professionals most often involved are nurses followed by physical therapists and home care aides. Other health care providers include respiratory and occupational therapists, medical social workers and mental health workers. Home health care is generally paid for by Medicaid, Medicare,long term insurance, or paid with the patient's own resources.
agency or nurse registry. The state licensing authority is the Florida Agency for Health Care Administration.[3]
[edit] Compensation
Registered nurses employed in the home care field receive on average around $22 to $30 per visit.[citation needed] Some as much as $45$55,[citation needed] and also receive 45 to 58 cents per mile tax free.[citation needed] Payment/reimbursement of other Skilled Services vary according to the specific discipline. Home Health Aides Caregivers working for state-licensed agencies bill at an hourly rate of about $11 to $25, depending on the state.[citation needed] A Home Health Aid employed by the agency is paid between $7.25 (current US minimum wage) and $10 or more per hour, depending on location.[citation needed] Home Health Aid employed by an agency can be paid up to $16-18 per hour.[citation needed] Direct hire caregivers are either employed by family or are self employed. A direct hire home care aid is paid between $8 and $15 per hour depending on location, number of hours, and experience.[citation needed] [edit] Supreme Court case relating to fees For years, home care work has been selectively classified as a companionship service and exempted from federal overtime and minimum wage rules under the Fair Labor Standards Act (FLSA). The Supreme Court considered arguments on the companionship exemption, which stems from a case brought by a home care worker represented by counsel provided by SEIU. The original 2003 case, Evelyn Coke v. Long Island Care at Home, Ltd. and Maryann Osborne, argues that agency-employed home caregivers should be covered under overtime and minimum wage regulations. Evelyn Coke, a home care worker employed by a home care agency that was not paying her overtime, sued the agency in 2003, alleging that the regulation construing the companionship services exemption to apply to agency employees and exempt them from the federal minimum wage and overtime law is inconsistent with the law.[4] The Supreme Court heard the case in 2009. In the court decision, the court stated the Fair Labor Standards Amendments of 1974 exempted from the minimum wage and maximum hours rules of the FSLA persons "employed in domestic service employment to provide companionship services for
individuals . . . unable to care for themselves." 29 U. S. C. 213(a)(15). The court found that the DOL's[clarification needed] power to administer a congressionally created program necessarily requires the making of rules to fill any 'gap' left, implicitly or explicitly, by Congress, and when that agency fills that gap reasonably, it is binding. In this case, one of the gaps was whether to include workers paid by third parties in the exemption and the DOL has done that. Since the DOL has followed public notice procedure, and since there was gap left in the legislation, the DOL's regulation stands and home health care workers are not covered by either minimum wage or overtime pay requirements.
In the 2004 data, just over 30% (30.2% or 385,500) of the total 1.3+million persons lived alone, but the study did not break this down by age groups. A large portion, 1,094,900 or 80.8% had a primary caregiver, and almost 76% (75.9% or 831,100 lived with the primary caregiver, typically the spouse, child or child-in-law, other relative or parent, in that order. (Paid help and the category of neighbor/friend/ or unknown caregiver would be, for the majority, were living with non-family (4.3%) or unknown living arrangement .) Most patients still need external help, even if the primary caregiver is a spouse.[citation needed] A total of 600,900 persons received personal care.[citation needed] [edit] Payment The study describes the population break-down by type of payment used.[5][citation needed] Of the 1.3+ million: 710,000 paid by Medicare - Medicare often is the primary billing source, if this is the primary carrier between two types of insurance (like between Medicare and Medicaid). Also, if a
patient has Medicare and that patient has a "skilled need" requiring nursing visits, the patient's case is typically billed under Medicare. 277,000 paid by Medicaid.-[citation needed] 235,000 paid by private insurance, or self/family - Private insurance includes VA (Veterans Administration), some Railroad or Steelworkers health plans or other private insurance. "Self/family" indicates "private pay" status, when the patient or family pays 100% of all home care charges. Home care fees can be quite high; few patients & families can absorb these costs for a long period of time. 133,200 all other payments - including patients unable to pay, or who had no charge for care, or those whose payment "source not yet determined or approved." Sometimes after "opening a case" (the formal paperwork process of admitting a patient to home care services, there can be a short period of time when the office has not yet received approval by one of two or more insurances held by the patient. This is not unusual. There can also be cases where the office must make phone calls to be sure a particular diagnosis is "covered" by the patient's primary insurance. This is not unusual. These delays explain, in part, a couple circumstances where payment source would be listed as "unknown."[citation needed]
Home care agencies are regulated by statutory bodies in three of the four home nations. The regulator's function is to ensure that home care agencies work within the applicable legislation: [edit] England
Regulator: The Care Quality Commission (CQC) The Health and Social Care Act 2008 The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010
[edit] Wales
Regulator: The Care and Social Services Inspectorate Wales (CSSIW)[13] The Care Standards Act 2000[14] The Domiciliary Care Agencies (Wales) Regulations 2004[15]
[edit] Scotland
Regulator: The Care Commission [16] The Regulation of Care (Scotland) Act 2001[17]
[edit] Northern Ireland Legislation covering the homecare sector in Northern Ireland is not yet fully operational (as at December 2007). Regulator: The Regulation and Quality Improvement Authority (RQIA)[18]
The Health and Personal Social Services (Quality, Improvement and Regulation)(Northern Ireland) Order 2003[19] Domiciliary Care Agency Regulations (Northern Ireland) 2007[20] Domiciliary Care Agencies National Minimum Standards (not published as at December 2007)