Measuring the Quality of Home Health Care
Home health is an important category of service delivery, especially for older people and those who have significant medical or surgical stays in hospitals.
Measures Cover Skilled Care Rather Than Personal Care/Homemaker Services
Home health as a category of service can be confusing to consumers. Many may not realize the distinction between skilled and unskilled care:
- "Skilled" home health care services are provided by nurses and physical, occupational, and speech therapists. These services are designed to achieve improvements in clinical symptoms and functioning.
- Personal care, or homemaker services, are provided by home care aides, either in addition to skilled services or by themselves. This kind of care is designed to provide assistance with activities of daily living such as bathing, dressing, toileting, eating, and walking, or with "instrumental" activities of daily living such as shopping and housekeeping.
The quality measures developed to date for use in assessing Medicare-certified home health agencies focus on skilled care and are far more outcome-oriented than most other measurement sets.
Most Common Payers
Most insurers, following the lead of Medicare, cover home health care only when skilled services are deemed medically necessary, although they will also pay for home care aides when needed while skilled care is being provided.
- Medicaid programs cover home care aide services in some circumstances in some States; much of this care is paid for by individuals and their families.
- Medicare pays for home health care only when delivered by Medicare-certified home health care agencies, which are required to submit data that can be used for quality measures.