HOME HEALTH CARE: INDUSTRY EXPERIENCES TREMENDOUS GROWTH

Home health care has become one of the fastest growing segments of the health industry. Officials in the industry point out the aging population, increased governmental pressure to hold down health care costs and advanced technologies make the future in this field look bright.

Some predict home health care will become a $20 billion industry by 1995.

An indication of the explosive growth of the home health care industry can be seen in the Cape Girardeau area, where at least 15 home health care providers are now listed in the telephone directory.

One of those providers is the Visiting Nurses Association (VNA), a non-profit agency created in Kennett in 1972.

Debbie Hayden, of the VNA's Cape Girardeau office, said the association has witnessed see a 56 percent increase in growth during the past two years.

Said Hayden: "Since last July, we've broken our monthly records for home visits. We have also added an advanced personal care program and an in-home program that provides housekeeping services for our patients. Last year, we also added a hospice program."

Hayden said the staff of the Cape Girardeau office has grown from six full-time and part-time registered nurses in early 1992, to seven full-time registered nurses, plus other nursing aides and certified home health aides.

"And we're getting ready to hire more nurses," she added.

Hayden said the type of home health care patient is also changing. "We're seeing more acute-care patients that require the high-technology medical care that was only available in the hospital until recently. We're also seeing a shift in referrals to home health care services from the hospitals to the family or family physician, as they become aware of the advantages of home health care services."

Hayden said the majority of nursing care now is hospital-based. But she said there are estimates that by 2000, the majority of nurses will have moved from the hospital to home health care system.

Carol Rees, of American Home Health Services, Inc., of Cape Girardeau and Marble Hill, said home health care is the fastest growing segment of the health care industry, with an annual growth rate of 26 percent per year over the next three years.

Rees said ABC Home Health Services, Inc. was founded in 1978, in Brunswick, Ga., and is now the nation's largest, privately owned home health care provider, with over 300 offices in 22 states and 7,500 employees.

Like many other home health care agencies, ABC offers Medicare certified services, including skilled nursing care, home health aides, and physical, speech and occupational therapy. It also offers home IV fluid therapy, personal care aides, sitters and live-in companions, and ostomy supplies. The agency operates in a 10-county area of Southeast Missouri.

Generally, physicians view the development of the home health care industry as a positive one for patient and family. But they also note the program has some drawbacks, such as paperwork.

Dr. Mark Kasten, a practicing physician and past president of the Cape Girardeau County Medical Association, says home health care allows doctors to dismiss patients from the hospital who have not completely recovered, but will receive continued care at home by a health care professional under the supervision of the doctor.

All treatment and therapy administered by a health care nurse or worker must be authorized by written or telephone orders of the attending physician.

"One of the biggest problems physicians have with home health care is the volume of paperwork that's involved," said Kasten. "Every time you speak to a nurse, or do anything for the patient, an order must be filled out and signed."

Kasten is also concerned that some people are taking advantage of the home health care system by asking for services that could be performed by family members, instead having Medicare pay for it.

When family members ask physicians to approve these non-medical related services, it puts them in a difficult position, said Kasten.

"Overall, home health care is a good thing," he continued. "And under the new health care reform system, home health care will continue to grow. At the same time, I believe there will be a closer scrutiny paid as to what type of services are offered at government cost."

Home health care began in this country in the late 1700s, when religious orders made home visits to care for the sick. There were few, if any, hospitals, so most health care was administered in the home by physicians and nurses. As more and more hospitals were built, the concept of home health care and home visits gave way to in-hospital care.

By the late 1800s, lay people were organizing and administering the delivery of home nursing services. These agencies specialized in providing unlicensed, skilled nursing care and taught cleanliness and the basics of home health care to patients and their families, a practice that remains at the heart of home health care today.

Home health care entered a new age when the Women's Branch of the New York Mission employed a graduate nurse to care for the sick in their homes. Graduate nurses were hired by the Los Angeles County Health Department in 1898 to make visits to the sick and poor. It was the first governmental health department to offer such services, and it was here that the concept of the "public health nurse" was born.

Insurance companies and government officials quickly realized the value of home health care as an alternative to lengthy and costly hospitalization. In 1909, Metropolitan Life Insurance Company offered coverage of home health care services to its policy holders.

In 1965 Medicare and Medicaid legislation was approved by Congress that provided for medical care for the elderly and poor. Included in the legislation was a federally financed home health care program that became the catalyst for tremendous growth in the home health care industry.

Today, home health care providers offer the same type of medical services now provided in hospitals, but at a much lower cost. The services range from such basics as blood pressure monitoring to the most sophisticated treatments.

In addition, physical therapists, speech therapists, occupational therapists, medical social workers and registered nurses now provide state-of-the-art health care services right in the patient's home, under a physician's supervision.

Studies have shown that patients recover faster at home, and a single home health visit costs one-tenth of an average one-day stay in the hospital.