America has a highly developed health care system, which is available to all people. Although it can be very complex and frustrating at times, it has come a long way from the health care organizations of yesterday. Previously, most health care facilities were a place where the sick were housed and cared for until death. Physicians rarely practiced in hospitals and only those who were fortunate could afford proper care at home or in private clinics. Today the level of health care has improved tremendously. Presently the goal of our health care is to have a continuum of care for the patient, one of which is integrated on all levels. Many hospitals offer a referral service or discharge plan to patients who are being discharged. The discharge planner is a person trained in assessing what the patient's requirements for health care will be after discharge from the hospital. This enables the patient to continue their care at a level that is most appropriate for them. Items reviewed for discharge planning include, but are not limited to, therapies, medication needs, living arrangements and identification of specific goals. There are many options available for persons being discharged from an acute care hospital. They can include home health care, assisted living facilities, long-term care or hospice. Home Health Care
According to Growing Old in America (1996), "Home health care is one of the fastest growing segments of the health care industry" (p. 114). Alternatives for home care can meet both the medical and non-medical needs of a patient. These services are provided to patients and their families in their home or place of residence. Home care is a method of delivering nursing care and other therapies as required by the patient's needs. Numerous alternatives are available for persons seeking health care at home. With transportable technologies such as durable medical equipment, oxygen supply and intravenous fluids there are countless possibilities for treatment within the home setting. As stated in The Continuum of Long Term Care "Home health programs range from formal organizations providing skilled nursing care to relatively informal networks that arrange housekeeping for friends" (p. 185). This has allowed for home care to quickly become an essential component of the health care delivery system in the United States. In a home health care situation the primary care giver is usually not the physician. The physician is communicated with by phone and provided documentation from the caregivers. The primary caregivers are usually the nurses and other team members who are involved directly with the patient's care. Although, the original order to begin home care must be initiated by the physician if skilled care is to be obtained. According to the 1995 Guide to Health Insurance for People with Medicare "Medicare pays the full cost of medically necessary home health visits by a Medicare-approved home health agency" (p. 5). This coverage must meet specific criteria, but it can be a relief to family members to know that their loved ones can be taken care of at home without worrying about the expenses. Unfortunately, if the care to be given within the home is termed "not medically necessary" the expense is not covered. This can include items such as meal and medication delivery, a percentage of necessary durable medical equipment, personal care and homemaker services. My experience with home health care agencies has allowed for review of services that are not covered by Medicare and/or private insurance. Health care services that are not included can become quite numerous. It is often difficult for family members to understand why specific services are not covered especially when they appear to be necessary for the care of the patient. These costs can add up quite quickly and the impact of the cost can become quite distressing for family members and patients on a limited budget. In these cases a social worker is...
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