Home Health:

The Need for a National Policy to Better Provide for the Elderly

HRD-78-19: Published: Dec 30, 1977. Publicly Released: Dec 30, 1977.

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The Department of Health, Education, and Welfare (HEW) administers the principal federal programs which provide home health care. The main home health care programs that are medically oriented are Medicare and Medicaid. Proposed changes to the Medicare and Medicaid programs include eliminating the requirement that beneficiaries be confined to their homes and be in need of skilled care, limitations on the number of home visists, and the addition of homemaker services in fiscal year 1978. Except for the removal of the skilled care requirement, the costs associated with these changes would not be prohibitive and could provide disincentives to institutionalization.

Most of the problems noted in a 1974 GAO report have been alleviated by the implementation of various provisions of the 1972 Amendments to the Social Security Act, and by better provider understanding, gained through experience, of Medicare's home health care requirements. Many physicians are still unaware of the types of services being provided by home health agencies, and states still have different requirements concerning the number of visits allowed under Medicaid. Until older people become greatly or extremely impaired, the cost for home services, including the large portion provided by families and friends, is less than the cost of putting these people in institutions. About 17 percent of those 65 years or over fall within the greatly or extremely impaired category, about one-third of whom are in institutions. At the greatly impaired level, where the breakeven point in cost is reached, families and friends are providing about $287 per month in services for every $120 being spent by agencies. At all levels of impairment, the value of services provided by families and friends is significantly higher than public agency costs.

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