What is home care?

Home care is only one type of long-term care (LTC). LTC provides services to people who need help in their everyday activities because of a chronic or disabling health condition. "Supportive" services form the core of LTC. They include help with bathing, eating, walking or going to the toilet—basic functions known in the LTC literature as activities of daily living or "ADLs." Supportive services also include help with household chores and other activities such as shopping, cooking, managing money and paying bills, or traveling to and from one’s home. In the LTC literature, these are known as instrumental activities of daily living or "IADLs."

LTC can be delivered in a nursing home, assisted living facility or other congregate setting, or in a person’s own home. When services are delivered at home, they are called home care.

Why should I learn about home care?

Although people often think LTC is provided only in nursing homes, LTC includes many different services, most of which can be provided at home. Yet most people don’t know a lot about these options. In a survey of people 45 and older, the AARP found that 85% of those over 40 years of age couldn’t make a good guess about the cost of LTC, nor did they know how they would pay for it if they needed it.[1]

Yet it’s likely they will need LTC at some point in their lives, if only for a short time. As they age, nearly 72% of those over 65 will at some time need home care, while nearly half will enter a nursing home.[2] However, only a small proportion of older people needs LTC at any one point in time: 12% of people 65 or older living in the community have LTC needs, while 5% of those over 65 receive LTC in a nursing home.[3]

Why do people need it?

Many different health conditions can cause someone to need help with everyday activities. Some of these include

Diabetes
Congestive heart failure
Multiple sclerosis
Spinal cord injury
Arthritis
Dementia

Some people, especially older people, tend to have more than one of these conditions. Because many of these conditions are not likely to be cured, people need help on an ongoing basis to lead the best lives they can. Services should help people to manage their conditions and maintain their ability to function, while at the same time allowing them to live lives that are as full and independent as possible.

Who gets it?

Though most of the people who receive LTC are over 65, many are younger (see Figure 1 [4]).

What types of services do they receive?

Some of the services that LTC recipients need are medical (wound care and the administration of intravenous medications, for example). However most LTC services are non-medical and low-tech (such as help with dressing or bathing). LTC can also include rehabilitation services aimed at helping improve physical functioning. Other LTC services include “palliative care”, which is aimed at making people comfortable and is meant for those in great pain or close to the end of their lives.

Most paid LTC is provided in nursing homes, despite the fact that many people prefer to receive services at home. Medicaid, the primary payer for most LTC services, directs 56% of its LTC spending toward nursing homes.[5] Increasingly, people are turning to assisted living facilities, which promise to provide supportive services in a home-like setting, although the quality of these facilities is a matter of some debate. Efforts are also being made to expand access to services in peoples’ homes and in their communities.

How much does it cost?

Home care is expensive and many people have no way of paying for it. However, on average, the average cost of a home health visit ($65 in 1997) is considerably less than a day in a hospital ($1078 in 1997) or nursing home ($232 in 1997) [6]. Because of the cost, family members and friends provide a great deal of LTC, receiving no payment for their services. The worth of their time was estimated at $196 billion in 1998 [7], more than the $150 billion spent on paid LTC services. It is estimated that $100 billion (or two thirds) of that $150 billion went toward nursing home care, while $50 billion (or one third) went toward services provided at home or in a community-based setting.[8]

Who pays for LTC?

Most health insurance does not cover LTC. Even Medicare (the health insurance program for people over 65 and some younger people with disabilities) does not help people who need LTC: it mainly covers short-term services at home or in nursing homes. People who need services on an ongoing basis often dip into their savings. Those who have no savings receive LTC through Medicaid, the health insurance program for people with limited means. (They often qualify because they have used up all of their savings paying for LTC.) Some people (who can afford the premiums) are turning to private insurance policies that cover the cost of LTC, but as yet, only about 7% of all LTC services are paid for this way. (see Figure 2 [9])

To learn more about LTC, explore these links:

Click here to investigate some organizations involved in LTC
A useful overview of LTC is available here
For more comprehensive and technical information on home and community-based services, click here

Footnotes

1. Roper. (December, 2001). The Costs of Long-Term Care: Public Perceptions Versus Reality. Washington, DC: AARP Public Policy Institute.
2. Alecxih LM. (1997). Who Pays, How Much? In Boyd, ed. Long-Term Care: Knowing the Risk, Paying the Price. Washington, DC: Health Insurance Association of America.
3. Komisar, HL, Lambrew JM, & Feder J. (1996). Long-Term Care for the Elderly. New York: The Commonwealth Fund.
4. Spector, W. D., Fleishman, J. A., Pezzin, L.E., & Spillman, B.C., The Characteristics of Long-Term Care Users. Paper prepared for the Institute of Medicine, Committee on Improving Quality in Long-Term Care, Washington, D.C., 1998.
5. Cited in Tilly J, Goldenson S, & Kasten J. (2001). Long-Term Care: Consumers, Providers, and Financing. A Chart Book. Washington, DC: The Urban Institute.
6. Haupt, B. J. (1998). An Overview of Home Health and Hospice Care Patients: 1996 National Home and Hospice Care Survey, Advance data from vital and health statistics; no.297. Hyattsville, MD: National Center for Health Statistics.
7. Arno, P., & Levine, C. “The Economic Value of Informal Caregiving”, Health Affairs 18(2): 182-188, 1999.
8. Feder, J., Komisar, H. & Niefeld, M. Long-Term Care in the United States: An Overview, Health Affairs 19(3):40-56, 2000.
9. Cited in Tilly et al., (2001).