Abstract
While everyone talks about the role and importance of health care continuum, its essence and definition are being changed and shaped under a variety of social, economic, medical, technological, and cultural factors. Statistically, more than 1.5 million Americans use the benefits of home-based care daily (Fox & Raphael, 1997). On the one hand, home-based care services range from managing chronic conditions to providing technologically complex home-based medical services. On the other hand, home-based care does not possess sufficient resources to become an essential component of health care continuum. Whether home-based care services are given a chance to grow and evolve depends on how well the current models of home care proliferate, and how well customers and providers of home-based care manage their limited resources.
Continuum of Care
Introduction
While everyone talks about the role and importance of health care continuum, its essence and definition are being changed and shaped under a variety of social, economic, medical, technological, and cultural factors. Statistically, more than 1.5 million Americans use the benefits of home-based care daily (Fox & Raphael, 1997). On the one hand, home-based care services range from managing chronic conditions to providing technologically complex home-based medical services. On the other hand, home-based care does not possess sufficient resources to become an essential component of health care continuum. Whether home-based care services are given a chance to grow and evolve depends on how well the current models of home care proliferate, and how well customers and providers of home-based care manage their limited resources.
Transitioning patients
Home health care “is the delivery of continued nursing and therapeutic services provided in a home-based setting” (Cowen & Moorhead, 2006). Home care is considered an after-care medical service, but it is true that home care is the critical and, probably, the most important component of health care continuum positioned to “bridge the gaps in care between hospitals and home, especially for high-risk groups” (Naylor, 2006). That home care works to facilitate the patient’s transition from hospital care to community integration is beyond doubts. Simultaneously, and when it comes to terminal illnesses, home care works to smooth the process of transitioning patients from hospital care to end-of-life care at home. It is due to home care that the patient gradually learns and is given an opportunity to adjust to the new conditions of living after being discharged from hospital. Professionals and scholars in health care suggest that the role of home care in transitioning patients from one level of care to another is particularly important for small patients (Perkin, Swift & Newton, 2007). Families believe that home provides a safer environment for a child and can thus facilitate his (her) integration with the community. In terminally ill patients, home care often works to prolong the child’s life and looks like a more comfortable place for managing end-of-life decisions and transitioning the child to end-of-life care. Due to the fact that “home care provides personal, social, and financial benefits” (Perkin, Swift & Newton, 2007), it may significantly relieve the burden of medical concerns, which patients are bound to carry in hospital-based environments.
Services
Home care is believed to be an exceptionally diverse domain of services. Home care services range from “high tech home-infusion therapy through skilled nursing and rehabilitative care to management of chronic conditions and assistance with activities of daily living” (Fox & Raphael, 1997). Home-based care covers medical nursing care, meals on wheels, home health assistance, full-time nursing care, rehabilitation care, hospice care, and even social services and counseling (Harris, 1997). Certainly, the list of home based care services is not limited to skilled nursing or rehabilitation. Everything depends on the specific needs of the patient.
Home care guarantees comfortable existence of patients as the critical component of successful recovery. For example, many patients are transitioned from hospital to home care with the need to maintain home nutrition support. In 2002, 344,000 people received home nutrition support in the U.S. (Ireton-Jones, 2007), and in this context home nutrition services both act as an effective transition from hospital-based to home care and expand the range of available home care services. Given that home-based nutrition support also implies the need for diet intervention, diet instruction, meal planning assistance, and continuous diet monitoring (Ireton-Jones, 2007), the whole list of home care services looks almost unlimited.
Home care services may also include intravenous transfusions, tracheotomy tubes, peritoneal dialysis, intravenous infusions, and even long-term use of ventilators (Perkin, Swift & Newton, 2007). Developing and using timetables, installing and using medical equipment in home environments, visiting patients on regular basis, and providing regular counseling and consultation sessions with family members – all these aspects can be readily included into the list of home care services. As long as specific medical services give the patient a sense of comfort and relief, and guarantees smooth transition from one level of care to another, it can comprise as many services as possible and needed by the patient.
Contribution
Certainly, home care creates an image of being an indispensable element of health care continuum and looks like the basis for successful transition of patients from hospitals to home environment and later, community. In this context, home care significantly contributes in the overall management of health care resources. Because home care is viewed as “a total support program for the home-bound and a maintenance program to ensure wellness and rehabilitation” (Martinson, Widmer & Portillo, 2002), it reduces the scope of emotional and counseling support a patient may need in hospital environments. Home care makes it possible to raise the effectiveness of hospital-based procedures by including more patients and decreasing the length of their stay. Home care offers almost unlimited opportunities for using the same resources and staff in both hospital and home-based environments; as such, integration of resources between hospital and home care becomes possible (Martinson, Widmer & Portillo, 2002).
Unfortunately, the extent to which home care contributes to the effective distribution of health care resources totally depends on how medical professionals and families overcome financial, social, and medical barriers, which home care creates. Home care faces numerous challenges which, if not addressed, may substantially hinder the overall effectiveness of resource management in health care. First, home care requires sophisticated management and sound financial support. Pharmaceutical supplies, housekeeping, diet and nutrition, and home nursing care need to be well-coordinated to maintain high quality of home care services. In reality, such support is not always available (Martinson, Widmer & Portillo, 2002). Second, medical and hospital staff still lacks sufficient education and training with regard to home care. There is no clear understanding of health care standards and the range of services that can be offered in home-based environments (Martinson, Widmer & Portillo, 2002). Third, as long as home care shifts the burden of medical care from hospitals to families, the latter are not always able to cope with their new roles; for many, home care becomes a threat to their lifestyles and careers. Perkin, Swift and Newton (2002) are correct in that “the worst home is not necessarily better than the best medical institution”. Finally, home care remains relatively poor in resources and can be viewed as marginal and ancillary. In most cases, home care operates without due physician’s involvement and is limited to nursing interventions and social support. These, certainly, do not contribute in the efficiency of resource management in health care (Perkin, Swift & Newton, 2007). As a result, whether home care contributes in the effective distribution of health care resources depends on a whole set of issues. With these issues unresolved, home care is likely to become a real burden for the whole health care continuum.
Future trends in health care
Given the scope of issues, which home care creates against health care continuum, as well as the obvious lack of resources to close these gaps, the prospects of home care are rather vague. On the one hand, the changing disease and technological patterns significantly raise the scope of home care services in the U.S. Since the beginning of the century, many diseases have ceased to be dangerous and no longer require hospitalization; that the nation is growing older is another factor favoring the growth of home care services (Harris, 1997). Gradual development of rehabilitation services and technological advancement have created favorable conditions for managing chronic and acute illnesses in home environments. Also, home care can potentially be an effective instrument of cost containment: hospitals seek to discharge patients at earlier stages of illness, using home care as an alternative to their presence in hospitals (Harris, 1997). Finally, as long as the state is striving to improve the quality of life among patients, home care is likely to become a new trend against institutionalization of care. “Some cultural and ethnic groups are especially reluctant to treat the chronically ill and elderly in this manner” (Harris, 1997), and home care can become a viable alternative and an effective solution to these cultural and ethical issues. Of course, all these factors will effectively work only if supported at the federal level, if combined with reliable reimbursement strategies, and if reconsidered from economic and social perspectives. Otherwise, and with the lack of available resources, the development of home care as a part of health care continuum will be doomed to a failure.
Conclusion
Home care is fairly regarded as the critical component of health care continuum. Home care shapes the basis for smooth and successful transition of patients from hospital to home and community environment. In terms of terminal illnesses, home care can prolong patients’ lives and facilitate the process of taking end-of-life decisions. The range of home care services is very broad. Also, home care seems to significantly contribute to effective distribution of health care resources, being a viable alternative to hospitalization. Unfortunately, a whole set of home care issues remains unresolved. The lack of professional education, the lack of physicians’ involvement, as well as the absence of stable financial frameworks makes the prospects of home care extremely vague. Without these issues resolved, home care will cease to be an effective instrument of health care delivery but will turn out to be a burden for the whole continuum of health care services in the country.
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