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Massachusetts Medical Society's
Physician Focus

April 2011

Home Health Care


  • Currently, about 8 million Americans require some kind of medical care in the home, a number that will jump dramatically as our population ages.

  • Projections are that by 2030, nearly 72 million people in the U.S. will be 65 or older. A 2011 report by the Centers for Disease Control charted U.S. life expectancy in excess of 78 years, the highest it has ever been.

  • The demand for home health care is expected to rise as people live longer and wish to remain in their homes, avoiding nursing homes or other living facilities.

  • In the best of circumstances, home health care should develop into an integrated, team approach, with the physician, nurse, home health aides, patient and family members all working together to provide optimum care.

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Home Care Alliance of Massachusetts

Home Health Compare

ElderCare Locator

U.S. Administration on Aging

National Association for Home Care & Hospice

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Home Health Care PSA

From left: Mavis Jaworski, M.D., Pat Kelleher, Robert Schreiber, M.D.
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Our population is quickly getting older, and with aging comes frailty. Further, the rates of chronic disease, such as diabetes and arthritis, are high and climbing higher. Under these conditions, the struggle for independent living by seniors becomes greater. Yet people are adamant: they want to remain in their homes.

And that’s one of the goals of home health care services.

“The reality is that people want to be in their homes,” says Robert Schreiber, M.D., a geriatrician and primary care physician. “And to do that, you sometimes need to be dependent on others for help.”

Dr. Schreiber, physician-in-chief at Hebrew Senior Life in Boston, joined Pat Kelleher, executive director of the Home Care Alliance of Massachusetts, and program host and primary care physician Mavis Jaworski, M.D., in a wide-ranging discussion of the many aspects of home health care in the April edition of Physician Focus with the Massachusetts Medical Society.

While home care seeks to keep people in their homes, it also has another aim: to keep people out of hospitals. “Hospitals are not the best place for older adults,” Dr. Schreiber says. “My goal in treating elderly patients is to get them out of the hospital as quickly as possible so they can get the right care in the right place, and the home is the best place for them.”

So what’s the first step to getting home care? “People should speak up if they feel the need,” says Ms. Kelleher. “Sometimes people don’t realize that they see mom or dad or grandma or grandpa going downhill. They should look for warning signs. If they’re taking a lot medications, or have memory or vision issues, or have trouble walking, speak up to your physician and suggest that mom or dad may need some help. A lot of referrals come from primary care doctors.”

Ms. Kelleher says that 80 percent of home care is being provided by family members, juggling the care of their own families as well as that of their parents or other elderly family members.

And that, says Dr. Schreiber, presents another big concern.

“Caregivers are under incredible stress,” he says, “and oftentimes become burned out and don’t realize it. I try to plant the seed with families that it’s important to have someone else relieve you. If the primary caregiver gets sick, and there’s no one else, the whole system collapses. Home care is not only taking care of the patient, it’s also taking care of the family.”

Both Dr. Schreiber and Ms. Kelleher agree that home health care today is vastly different from the care of years ago. Ms. Kelleher says that while home services such as visiting nurses have been around for many years, today’s care runs the gamut, from very skilled services to those that just maintain independence. And the complexity of care that can be administered at home has also increased.

But regardless of the level or the quantity of services for an individual patient, all those involved must play key roles.

“In order to do the best,” Dr. Schreiber says, “it really takes a team of health care professionals and home care providers, so that when things go wrong, everyone can be alerted. The patient and the family are really the captain of the health care ship, and we’re the crew.”

He concludes with an important message for those contemplating home care services. “What I tell families,” he says, “is that home care is there to help, but family members still need to be overseeing and advocating so your family can get the right care.”

Watch the accompanying video for the complete conversation, which includes information on how to access home health services, how agencies are credentialed, what you should consider when deciding the services you may need, and additional resources on home health care services.

MMS/Richard Gulla