There are several significant issues that impact the future of home care in 2007 and beyond including:
– The gaps in transitions from one setting or provider to another;
– The increase of chronic care leading to service needs for many years;
– The strain on family caregivers, who provide 80% of all chronic care needs. Staffing Shortages: Increasingly, there is a shortage of skilled staff at all levels of the home care industry. In addition to recruitment activities by educational institutions to train nurses, social workers, rehabilitation therapists and nursing assistants, overcoming these shortages will require help from the federal government in the area of immigration policies. Currently, there are efforts to import workers from other countries, but the issues of training, housing, visas and job assignments remain complex. Furthermore, the increasing need for chronic custodial care means that more home health aides and nursing assistants will be needed to provide support for people who are experiencing increasing longevity. These staff are typically hired by families as independent contractors, which often means that no one is paying into the Social Security and unemployment systems for them. The implication of this is that they will not have a safety net income when they reach retirement age and they are also being excluded from participation in the Medicare system. These important workers are often left without a financial future because of lack of funding for chronic care. Transitional Care Issues: Transitions occur whenever a patient moves from one setting in the healthcare system to another or back home for follow up care. Often it is at the point of transition that care plans break down from a lack of communication, education, information and from a redundancy of procedures that lead to inefficiencies and frustration for the consumer. This is largely due to different funding sources for each level of services and the attendant liability issues that require multiple assessments for each service. In addition, since services are funded only for the identified “patient” the family support system is often left confused about what care is available and their responsibility to provide care in the future. With the increasing emphasis on the need to save money for private and government funding sources of healthcare, there will need to be greater efficiencies of information flow, increased training for family caregivers and better coordination of care with fewer redundancies in order to meet the growing needs of our aging population. National healthcare policy will have to recognize that coordination of care and information among providers will have to become a focal point of service provision. This will need to be balanced with increased concerns about liability issues if multiple providers utilize a single assessment and plan of care in the provision of services across settings. Chronic Care Crunch & the Need for Caregiver Support: Although there has been a trend toward the “compression of mortality” into the last few months of life, there has also been a counter trend in the increase of chronic care needs due to the advances in medical care of diseases that used to significantly shorten the life span. Most of this chronic care is provided in the community setting by a combination of family, private home healthcare workers (mostly nursing assistants) and social service agencies. The implications of this for the healthcare system is the need to better educate and support the family caregivers and community service providers about the needs of care recipients. This becomes especially important in caring for an aging population in which the family caregiver is also likely to be an elder with health concerns of their own. The cost of caregiver burnout and the excess disability that comes with it will end up being very expensive if family members dont have proper education, support, respite and reliable in-home staffing. This cost in the community will have a rebound effect on the entire healthcare system if the family caregiver becomes disabled in the process of giving care. Conclusions: Home healthcare will need to become better organized and coordinated with acute care settings, rehabilitation services, community service agencies, and family caregivers. The passing of information about the plan of care will have to be developed in such a manner that issues of both privacy and liability are addressed, while still holding providers accountable for quality care. The need for education and support services for home healthcare workers and family caregivers will be crucial to maintaining people with chronic health issues in the community. This includes a financially viable system of compensation and employment benefits for home healthcare workers. The issues of both training and appropriate compensation will make it possible to address the staffing shortages that are already looming.
