Need for Home Health Care and Characteristics of the Industry
In the past century, Americans have experienced an increase in life expectancy from 46 and 48 years for males and females in 1900 to 75 and 80 years for males and females, respectively, in 2000 (Heron, 2007). The proportion of the US population aged over 65 was 14.3% in 2000; this is expected to rise to 25.9% by 2050 (United Nations, 2009).
An aging population will require more health care services, of a different type, than younger residents. In a 2011 CDC report, the majority of home health care patients were 65 and older (68.5%) and 64.0% of those patients were women (Caffrey, Sengupta, Moss, Harris-Kojetin, & Valverde, 2011). This report also discusses differences in length of service between older and younger patients. The mean length of service was longer for those patients under age 65, as compared to their older counterparts (474 days and 242 days respectively). There was also a difference of length of service between proprietary agencies (mean = 374 days) and non-profit agencies (mean = 203 days). Older individuals are more likely to suffer from functional decline subsequent to hospitalization, regardless of a positive cure of illness (Creditor, 1993). However, many aging individuals prefer to age and be treated within their own home, often times with great success (Gill et al., 2002; Romanow, 2002). Moreover, the majority of older adults report a preference to die within their home (Brazil, Howell, Bedard, Krueger, & Heidebrecht, 2005). Maintaining the independence of older individuals requires an emphasis upon home health and, as necessary, hospice services. Home health care provides assistance with activities of daily living (ADLs); such as bathing, dressing, eating, walking, toileting, and continence (Batavia, DeJong, & McKnew, 1991), as well as medical and nursing care. By the year 2050, an estimated thirteen million people will require assistance with these ADLs, thus requiring a more efficient and effective home health care industry (U. S. Department of Health and Human Services, 2003).
The home health industry in the United States is comprised of approximately 9,284 agencies that served a total of 7.1 million patients in 2000 (Pearson & Bercovitz, 2006). An additional 513,000 patients used hospice care in the year 2000 (FASTSTATS, n. d.; Hospice Association of America, 2008). In 2000, approximately 70 percent of home health patients were 65 and older; with the most prevalent admission diagnoses being heart disease (11 percent), diabetes (8 percent), cerebral vascular disease (7 percent), COPD (5 percent), and malignant neoplasms (5 percent). Other prevalent diseases included: congestive heart failure, osteoarthritis and allied disorders, fractures, and hypertension. The average length of service was 312 days (Heffler, Smith, Keehan, Clemens, Won, & Zezza, 2003). The clinical picture is one of complex diagnoses managed over an extended period of time.
Home health and hospice care is different from other types of care in that the patients are not centralized and planning efforts for service coordination must be strengthened (Pearson & Bercovitz, 2006). The interaction between provider coordination across many disciplines and lack of a common site for service delivery exacerbates the need for a tool to aid coordination of care. Fragmentation in care can lead to medical errors and quality shortcomings, which in turn lower medical outcomes and lower efficiency (Brailer, 2005). Innovations in home health care to improve care coordination and reduce communication failures for home health agencies include the use of health information technology (HIT) (Coleman, 2003; O’Malley, Grossman, Cohen, Kemper, & Pham, 2009; Rialle, Duchene, Noury, Bajolle, & Demongeot, 2002).
In particular, the use of point-of-care documentation within home health services has been found to have a significant relationship to quality improvement and coordination between fragmented health care services (Price & Kricka, 2007). Electronic point-of-care documentation, when integrated to a larger electronic medical record (EMR) system, provides patient information to different providers as they treat the home health patient (Hägglund, Scandurra, Moström, & Koch, 2007). Point-of-care (POC) technology allows for clinical information access across different sites of care (Williams, 1999). This technology allows for interoperability with other systems, thus standardizing nurse notes, which is seen as an improvement from unstandardized, paper-based systems (Yao, Schmitz, & Warren, 2005). Point of care documentation can also be used to send electronic reminders, which have been shown to improve compliance to medical guidelines (Kheterpal et al., 2007).