The holidays have passed, toasts have been shared, and we all survived the millennium bug. Or did we? Maybe there were no mass power outages and no one lost their money in the bank, but does that ensure that the millennium bug is safely behind us?
Most people identify the millennium bug as a computer-related problem. Because our computers are still running we could safely assume that we have survived a major crisis. Yet, perhaps the bug is still alive and well. I believe it resides in the lawmakers and healthcare providers that see 2000 and beyond as a replica of 1999 and the past.
In order to go forward, we must reflect on the past.
The 1880s: Home care in America is provided by the "well-to-do" to educate and assist those less fortunate.
1912: The American Red Cross establishes rural home care for "sick country people."
1947: Modern home care in the U.S. is started through the foundation the hospital without walls, by E. M. Bluestone and M. Cherkasky in New York. Home care costs are $3 per day (versus the $12 per day hospital cost).
1950s: The polio epidemic introduces physical and occupational therapy in the home.
1965: Medicare legislation provides home care as a benefit.
1987: Home care services grow to serve more that 6 million recipients.
1996: 2.4 million people receive home care services.
1997: Congress passes Balanced Budget Act.
1998: HCFA reports 14% fewer recipients of home care since 1997 statistics.
Since the days of service only to the poor and diseased we have advanced to modern clinical practice that optimizes recovery and resolution. But, as we reflect on where we have been it is imperative that we set a course on where we want to go. Cutting home care services when our aging population is the fastest growing segment of our population is a giant step backwards. As we envision a better healthcare system we must chart a course that optimizes health, healing, and dying in the best place-the home.
I see the turn of the millennium as both an opportunity and a challenge. As home care providers we need to see what the future should be and take action to ensure its fruition.
If it is acknowledged as important, home care could take on these forms over the next decade:
Access to home care will be available in all areas of the United States.
Home care will be the pivotal point for chronic healthcare services.
Home care services will expand to an even greater percent to the young and disabled.
Computer technology will allow home care providers to care for more patients more efficiently and with greater validated outcomes. This care will be covered by all payors.
Hospice guidelines will allow for more timely referrals to maximize patient and family support in the dying process.
Home care regulations will be reasonable and consistent.
Documentation requirements will be nonduplicative and will include consistent and reliable outcomes.
Home care providers will spend more time with their patients and less time with documentation.
Reimbursement will provide fair pay to those who provide high-quality services at competitive costs.
Home care research will provide undisputed data showing both outcomes and financial benefits.
Fraud and abuse will not be the first thing heard from legislators because there will be so little of it.
These goals are both realistic and obtainable but require action. Home care of the millennium and beyond is in our hands today. These and other dreams can become a reality by continuing with our research and legislative efforts. Although much has been accomplished in the last 2 years, our work has just begun.
Millions of patients are counting on us!