Academic journal article Health and Social Work

Provider and Consumer Profiles of Traditional and High-Tech Home Health Care: The Issue of Differential Access

Academic journal article Health and Social Work

Provider and Consumer Profiles of Traditional and High-Tech Home Health Care: The Issue of Differential Access

Article excerpt

Medicare annual home health care expenditures have grown steadily as the number of Medicare-certified home health care agencies has reached an all-time high. Growth has been particularly rapid among Medicare-certified hospital-based and proprietary agencies, each representing a third or more of all certified agencies. As of 1994 there were 15,027 home health care agencies in the United States, of which 7,521 were Medicare-certified home health care agencies; 1,459 were Medicare-certified hospices; and 6,047 were home health care or hospice organizations not participating in Medicare. It is estimated that more than $23 billion was expended for home health care in 1994, representing approximately 3 percent of national health care spending. The largest single payer of home health care services is Medicare, accounting for 37.8 percent of total home health care expenditures, followed by out-of-pocket payments (31.4 percent) and Medicaid (24.7 percent) (National Association for Home Care [NAHC], 1994).

Although home health care has grown at a rapid pace during the past two decades, it still represents a small proportion of spending for all personal health care services. Approximately 8 percent of Medicare and 5.5 percent of Medicaid expenditures were for home health care services in 1994. Even so, the home health care industry continues to expand rapidly. In 1990, home health care experienced a 19.2 percent jump in new job growth, almost triple the rate of growth for the health care industry in general (NAHC, 1991a). The number of home health care workers in home health care agencies totaled 657,622 in 1994 (NAHC, 1994).


Accompanying the expansion of home health care has been the continuous growth in the range of high-technology medical procedures available to older adults (National Center for Health Services Research and Health Care Technology Assessment, 1988; Office of Technology Assessment, 1984). Medical and communications technologies have been successfully miniaturized and made portable so they can be used in the homes of older adults. Such devices and techniques are no longer restricted to the confines of more traditional institutional settings such as hospitals and long-term care facilities.

The taxonomy of technology is subject, according to Haber (1986), to a binary classification system that distinguishes between health care technology and ecological technology. Currently available home environmental enhancement devices include communications equipment such as automatic alarms signaling the need for help; automatic telephone dialing systems; electronic safety systems and monitors; in-home computers for self-instruction on taking medication, maintaining proper nutrition, and promoting self-care; and even robotics. Treatment-related high-tech services available in the home include artificial nutrition and hydration, mechanical ventilation, intravenous therapy, apnea monitors, bone growth stimulators, home dialysis, chemotherapy, platelet infusions, morphine drips, intravenous (IV) infusion of fluids and medication, antibiotic therapy, and computerized health monitoring equipment (Kaye & Reisman, 1991). When such technologies are combined with some of the less complex devices benefiting homebound people, such as adaptive devices on tubs, beds, and stairs and devices that aid in dressing, bathing, grooming, and cooking, a complex home environment begins to take shape.

Professionals providing home health care services can expect to find these new procedures and devices in patients' homes with increasing frequency. In fact, the offering of high-tech products and services represents the segment of the home health care industry with the greatest projected rate of compound growth (Kane, 1989).

The emergence of services delivered in the home, including technology-enhanced interventions, has both advantages and disadvantages. Haddad (1992) identified as advantages the presence of family and familiar surroundings, less danger of contracting infectious diseases, less expense, and greater opportunity for activity and participation in family life. …

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