The early nineteenth century witnessed the initial stages of the home health care industry that offered qualified nurses to take care of the poor and sick in their homes. In 1909 when Metropolitan Life Insurance Company started to write policies that comprised of home health care, this industry became very popular. This company is credited for paying the first compensation for home health care industry. This gave rise to the birth of organized home health care.
The Great Depression in 1929 caused several businesses along with home care industry a lot of hindrances and struggle. This went on till the follow-up visits made by nurses after hospital discharge became reimbursable by the Medicare Act of 1966. The home care industry became most feasible and practical when Medicare in an attempt to reduce hospitalization costs set up DRG's program (Diagnostic Related Group). This laid down that some disease or hospital practice needed a certain stay period. So the discharged patients were more sick compared to their DRG counterparts.
The story does not finish with DRGs. This in fact was the commencement of patient care vs. medical ethics debate. This subject shall be soon addressed in the present health care reform segment. The price of health care is the issue. Questions like how much does a human life cost and how long one should pay for keeping alive a person after he ceases to be a contributor to the society need to be addressed.
Home health care industry needs to answer these questions. The main intention of the DRG programs was to cut down the hospital stay in order to lower hospitalization costs. Thus this becomes a challenge to the agencies. But gradually home care started becoming expensive. The Balanced Budge Act of 1997 hand one major side effect. It limited the benefit days to the patients under home health care thereby lowering the compensations to the various home health care agencies. This resulted in many of these agencies going out of business.
The price to take care of a patient will always stay an issue. There was a growth of nosocomial diseases in hospitals that lead to heavy health care costs. Patients started getting discharged in a much sicker condition than before. This put additional burden on the family of the patient to make available good care once the family member is home. Also majority of the people were working. Home health care agencies that provide services were unable to discharge patients when they exceed their Medicare days if they are in a bad condition or its not safe to depart from them without any nursing services.
In case the home care agency declines admission of a patient who seems sicker than the number of reimbursement days allowed by the government, the patients' family does not have too many choices. In case of the patient being discharged without any adequate follow-up care, the patients' family can seek services of a qualified agency that could strain on emergency room visits and re-hospitalization leading to more compensation issues. Such questions are difficult to answer more so in cases where cost is to be taken care of. But, as time passes, such questions will continue to haunt till there are satisfactory answers to them.