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This chapter provides an overview of healthcare-related changes from a big-picture perspective. These are needed to best understand where home care fits into the bigger picture of healthcare as a whole. With this in mind, the overwhelming trend in healthcare can be summarized in one word: change.

This chapter seeks to identify some of these changes and their impact on home care. For purposes of this chapter and book, I am defining home care holistically as any kind of health-related services provided at home. A classic and comprehensive definition of home care is one by Claire F. Ryder Warhola from the U.S. Public Health Service, Department of Health and Human Services. It states that home care is:

“…that component of a continuum of comprehensive healthcare whereby health services are provided to individuals and families in their places of residence for the purpose of promoting, maintaining, or restoring health, or maximizing the effects of independence, while minimizing the effects of disability and illness, including terminal illness. Services appropriate to the needs of the individual patient and family are planned, coordinated and made available by providers organized for the delivery of home care.” (1980)

But where exactly does home care fit into and intersect with the bigger picture of healthcare and its delivery? And where exactly are the intersections in healthcare today that support this continuum and alignment with the “promoting of health” mentioned in this definition?

These and other questions may best be answered by reviewing where we are, how we got here, and how home care might be a solution or a large part of the answer to the major disruption of illness and some of the trends seen in healthcare. The following sections highlight some of those trends.


Many forces and factors are driving the needed changes to the healthcare system. As you read this chapter, try to pretend that you are a neophyte in healthcare—that you do not know much about healthcare and have “new eyes” to take in, thoughtfully review, and reimagine it as it could be. This fresh approach can help you have a better understanding of this chapter and bring new perspective to your work!

Cost, Quality, and the Affordable Care Act

Discussions about the pros and cons of the Affordable Care Act (ACA) will continue, but the focus must be about patients, quality, access, and cost. The passage of the ACA means generally mechanisms are now in place to help individuals access some kind of health insurance. Since the ACA was passed, 16.4 million formerly uninsured people in the United States now have health insurance (U.S. Department of Health and Human Services, 2015).

Parts of rural America still have challenges related to accessing healthcare, especially ...

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