Home and Community Based Care Services

1.0 Introduction The issue of health care, particularly long term medical care has always been of great concern to the different stakeholders involved in the United States of America, particularly the citizens, government relevant policy makers. Levinson (p. 4) purports that in the last few decades States in the US have modified their approaches to the provision of long term Medicaid financed care services. Instead of offering a great percentage of this care in institutions such as nursing homes as was previously the case, States are currently offering this care in home and community based contexts. According to Levinson (p. 4) States are able to offer such care by utilizing the 1915(c) HCBS waiver programs. The persons served in these programs are usually the elderly who are aged above 65 years. In the 2010 fiscal year the Medicaid spent at estimated $ 8.9 billion in offering these services (Levinson, p. 4). Long term care is described as an assortment of social, medical and personal care services that are necessary for individuals whose functions have been incapacitated due to old age, injuries or other serious medical conditions. Long term medical care in the United States of America is comprised of nursing home care, home and community based care and informal care. More often than not the long term care provided in the American home and community based care institutions is consumed by the aged and disabled or those that, in spite of not being aged, suffer from mental or physical dysfunctions. Home and community based care is described as the formal medical services that are offered to patients in their homes or community based contexts. Home and community based care may be paid from either public or private funds. This paper aims at analyzing home and community based care in the United States of America. 2.0 Literature Review (a) History of Home and Community Based Care According to Duckett and Guy (p. 123) the home and community based care in the US was first established in the 1980s under Medicaid. Medicaid home and community based care was endorsed under the 2176th Section of Omnibus Budget Reconciliation Act in the year 1981. Upon its establishment home and community based care was constituted of a number of services for instance respite care, personal care, case management, chore services and homemaker. A majority, if not all, of these services were established for the purposes of ensuring that rather than be institutionalized and occupy beds in nursing homes, the aged American population could be assisted at home or in their communities. Congressional Research Service (p. 162) states that the States in America were then forced to apply for waivers from the federal government due to the fact that the home and community based care program was not dealt with in the regular Medicaid schemes. Eight years after the program was established, the end of 1989, 36 of the American States had requested for the waiver. It is an unarguable fact that several decades since it was established the Medicaid waiver program has enabled many Americans whose socio-economic backgrounds are disadvantaged to attain the necessary medical to enhance their quality of life. (b) Factors leading to Establishment of HBCS There are a number of factors that led to the establishment of home and community based care. Firstly, it was discovered that a very inconsistent percentage of Medicaid resources were being utilized in institutional long term care. In addition to this, a number of investigative studies carried out in America’s health system in the 1980s revealed that and estimated 34% of the patients in nursing homes financed by Medicaid could comfortably remain in their home and community settings if only these settings were equipped with supplementary supportive services (Duckett and Guy, p. 123). The third factor that led to the establishment of home and community based was the realization that there existed a particular “institutional bias” in the eligibility and benefit frameworks utilized in Medicaid which led to unnecessary utilization of Medicaid institutional care (Duckett and Guy, p. 123). According to Lakin and Hall (p. 149) it also become necessary to establish home and community based care services when the patients in intermediate care and nursing institutions testified repeatedly of the inadequate quality of life that characterized the care agencies. More over the number of legal suits from such patients against the agencies of health care caused the courts to judge that people with growth disabilities undergo deinstitutionalization (Duckett and Guy, p. 123). (c) Beneficiaries of Home and Community Based Care Levinson (p. 5) claims that in the year 1981 the American Congress enhanced the domain and availability of home and community based care by allowing states the option of setting up Medicaid 1915 (c) HBCS waiver programs. Such programs allow states the freedom to waive particular Medicaid requirements so as to be able to present the target group with a more expansive assortment of services rather that institutionalizing them. The waiver programs are expected to serve people from three distinct groups. These are the beneficiaries of the home and community based care and they include the aged population that is aged 65 years and above and are disabled (or not), persons suffering from mental illnesses and persons with intellectual or development dysfunctions (Levin, p. 5). It is noteworthy that the largest percentage of beneficiaries of home and community based care are those in the first group (the aged and/or disabled). Levinson (p. 6) claims that there are a number of categories of home and community based care. (d) Categories of Home and Community Based Care Home and community based health care in the United States of America can be categorized into five main groups. • Home Health Care Services This category of home and community based care is tasked with the responsibility of caring for persons with medical conditions for which they received health care in their homes. Home health care services not only offer assistance to individuals with personal care but also perform medical related rituals such as dressing wounds, giving medication and monitoring vital signs (Levinson, p. 6). • Homemaker Services Homemaker services in home and community based care refer to offering patients management services such as laundry, changing and making beds, grocery shopping and other light house keeping tasks (Levinson, p. 6). Homemaker services are also commonly referred to as Instrumental Activities of Daily Living, IADLs. • Personal Care Services Personal care assistance is purposed to health the patients in the accomplishment of their daily personal tasks for instance using the bathroom, eating, dressing, mobility, grooming and transferring. Another terminology commonly used to refer to personal care services is Activities of daily Living (ADLs). • Skilled Health Care Services The third category of home and community based care services is skilled health care services that presents the patients with skilled and registered occupational, physical and speech therapists as well as expert registered nurses who then offer the patients expert nursing and rehabilitative therapy at home (Levinson, p. 6). • Meal Services This service which makes up part of home and community based care it utilized in the provision of meals to individuals that need it in their churches, homes, senor centers or schools or any other centers in their communities that they prefer (Levinson, p. 6).. The meal service programs in home and community based care are commonly referred to as congregate meal programs. There are a number of different home care providers of varying expertise, educational backgrounds, experience and costs. The most common are the licensed home care agencies that are supervised and controlled by the state government, the independent providers that are employed directly by family caregivers and finally the non-certified agencies. 3.0 Benefits and Challenges of Home and Community Based Care Services There are a number of advantages and disadvantages that are associated with the home and community based care services in the United States of America. The first major advantage of this program is the fact that it enables states in America to offer its citizens intensive medical or health services that are not addressed in the state health care schemes. In addition to this, the home and community based care services are very beneficial due to the fact that serve to enhance the number of providers the present patients with intensive HBCS. The home and community based care waiver program is also beneficial due to the fact that enables states in the nation of America to gain the experience that they needs in establish effective and sustainable costs for individual care schemes. In spite of the advantages that typify home and community based care services a number of disadvantages that characterize home and community based care services. One of the first main challenges is the fact that offering patients medical care and related services away from the scrutiny of observers may lead to the patients getting medical care that it not of standard quality. In addition to this, the patients, particularly the elderly and mentally incapacitated, may be mistreated if exposed to unethical care givers. In addition to this, the development, implementation, execution and evaluation of the waiver program in every single in the nation of America is not an easy feat to carry out or attain successfully. The application and implementation of home and community based care is also characterized by a number of disparities from one American state to the next. 4.0 Conclusion In the present day more and more individuals requiring long term health care services prefer to remain in the comforts of their homes or community institutions of their choice, in the company of their loved ones, rather than be institutionalized in nursing homes. The home and community based care program which is funded by Medicaid offers patients in the target group a number of alternatives in order to meet this need. As already indicated in this paper, the persons served by the home and community based care services financed by Medicaid are usually the most vulnerable persons in society who are either very elderly and those with very serious mental and physical dysfunctions. Such persons tend to have very limited financial resources. Rather than receive medical care in institutionalized settings, the beneficiaries of this program receive medical care in their own homes or community settings of their preference. Upon its establishment home and community based care was constituted of a number of services for instance respite care, personal care, case management, chore services and homemaker. Although at times the patients are cared for by expert and register nurses and therapists, a majority of the programs in HCBS allow the patients to receive care from relevant others with limited professional training for instance family members and friends. This paper has also described a number of challenges and benefits that characterize the home and community based care services. It is an unarguable fact that several decades since it was established the Medicaid waiver program has enabled many Americans whose socio-economic backgrounds are disadvantaged to attain the necessary medical to enhance their quality of life. In order to ensure the effectiveness of the home and community based care service the American government needs to conduct investigative studies that will enable the collection of data that can be used to accurately explain the transitions by the beneficiaries of home and community based care services from one condition to another. Conditions range from longevity, health, functional statuses and utilization of services. Work Cited Congressional Research Service, MEDICAID Source Book: Background Data And Analysis, A Report prepared for the Subcommittee on Health and the Environment of Committee on Energy and Commerce, U.S. House of Representatives, Washington, DC: U.S. Government Printing Office, (1988) Duckett, Mary Jean and Guy, R. Mary: Home and Community-Based Services Waivers, Health Care Financing Review, Vol. 22, No. 1, (2000), pp. 123-5 Lakin, K. C. and Hall, M. J: Medicaid Financed Residential Care for Persons with Mental Retardation, Health Care Financing Review, 11 (2), (1990, pp. 149-160) Levinson, R. Daniel: Oversight of Quality of Care in Medicaid Home and Community-Based Services Waiver Programs, Department of Health and Human Services- Office of Inspector general, (2012) pp. 4-20