The market for home health care is booming


With the demographic shifts currently underway in the US, the population is growing older. By 2019, the number of people aged over 65 will be larger than the number of people aged under 51. With this ageing population, the need for health care will grow considerably too. Given the increase in demand for health care solutions for older people in particular, alternatives to traditional care are being considered. Traditional care refers to the system of hospitals, nursing homes, special facilities, and so on – what you probably imagine when you think of health care. This system is well suited to acute and emergency care needs, such as when a patient requires emergency surgery after an auto accident. However, traditional care is not so well suited to the treatment of chronic conditions and the long-term care of the elderly or of patients with disabilities or physical limitations2,3.

An alternative to traditional care that is especially well suited to elderly patients is home health care. This is a system whereby care is given to patients in their own homes, and is aimed at patients who are well enough to not require round the clock care in hospital, but who still need treatment and support. First, the patient is assessed at the hospital for their suitability for home health care, then their home is assessed for things like heating and running water. If approved, the patient is sent home and the hospital will send physicians, nurses, or other staff to visit, and may also use remote systems to monitor the patient's vital signs. Caregivers at home can teleconference with physicians or other staff to get advice or to inform them of the patient's progress. This type of system has been established in countries including the U.K., Canada, and Israel4.

What are the outcomes for home health care treatment?

One of the reasons that home health care is promoted as an alternative to traditional care is that it leads to better outcomes, in terms of patient health, patient comfort, and patient experience of the care. A 2014 study by The Alliance for Home Health Quality & Innovation found that after receiving home health care, 89% of wounds improved or healed after an operation, 67% had less pain when moving around, 66% got better at bathing, and 64% had improved breathing5. Similarly, a trial at Johns Hopkins found that patients who were given home health care spent one third less time in recovery than patients treated in hospital, and that the rate of complications was considerably lower in home health care patients4. And it is preferred by patients too: when given the option to receive their treatment at home, 69% of patients chose this option3.

Another significant advantage of home health care compared to traditional care is that it is significantly cheaper to treat patients at home. At John Hopkins, their trial of home care found that the average cost of at-home care was almost one third lower than the cost of traditional hospital care (32 percent less, or $5,081 for home care vs. $7,480 for hospital care)4. In fact, home health care has been suggested as a cost-saving measure to salvage the unsustainably high cost of health care in the US5. Another study into Medicare users found that the average cost of home health treatment was $20,345, compared to $28,294 for other treatment venues - around a 28% saving6.

Concerned readers might worry that because it is less formalized and less strictly structured, home health care could lead to lower quality standards. But evidence shows that this is not the case. In addition to the patient outcome statistics, overall assessments of the quality of home health care have found that home health care meets quality standards at similar rates to traditional hospital care3. Overall, we can say that home health care is outpacing traditional healthcare in terms of both economy and quality.

Why is home health care so effective?

It might seem counter-intuitive that home health care would bring about better outcomes than traditional care, given that the patients are in less direct contact with physicians, nurses, and other clinical staff. However, this overlooks the significant benefits of receiving care in one's own home. In terms of health outcomes, patients are much less likely to pick up hospital infections, which elderly people are particularly vulnerable to. Patients can also be cared for by friends or family, and this one-on-one caring leads to fewer mistakes than overworked caregivers who are looking after many patients.

Perhaps most importantly, home health care is strongly preferred by patients, who place great value on living in their own homes rather than spending time in a hospital or other treatment venue. Even among patients with disabilities who require 24-hour care, at home caring is preferred by 73% of patients*. Staying in their own home gives patients a sense of familiarity and agency over their health, and these psychological factors play a part in improving physical health outcomes. Remaining in their home also makes it easier for friends and family to visit the patient and to offer help, and this social support is a key factor in physical health outcomes as well.

Home health care is an example of the trend towards patient-centered care, in which the individual patient's needs are taken into account as opposed to an institutional system in which patients are treated uniformly. Not only does home health care take into account the patient's preferences and give them a sense of

dignity and respect, it also helps them to recover faster. Finally, the financial impact of home health care cannot be overlooked. Given that many patients already have a home in which they feel comfortable and which is heated and outfitted to their taste and to meet their needs, significant money can be saved by letting patients recover in this space rather than paying for the operation of a brick and mortar hospital. This approach to treatment can bring down the costs of health care by roughly one third when compared to a hospital stay, for potential savings in the millions of dollars every year.

References:

1 http://journals.sagepub.com/doi/pdf/10.1177/1084822316666368

2 https://www.ncbi.nlm.nih.gov/pubmed/16330791

3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749163/

4 http://www.commonwealthfund.org/publications/newsletters/quality-matters/2011/august-september-2011/in-focus

5 https://www.ncbi.nlm.nih.gov/books/NBK315921/ - _sec_000033

6 http://www.ahhqi.org/images/pdf/future-whitepaper.pdf

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