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This chapter provides an overview of what home care “looks like” in the home. As you read this section, it is easy to see that varying kinds of programs, services, and models can all be under the umbrella of these seemingly two simple words: “home care.” Home care and home healthcare can mean many things. In the United States, the addition of the word health is often used in relation to Medicare and other insurance-covered care—meaning the medically focused care model.

Yes, many people need this model and its level of expertise and care. However, it is important to understand the scope of services that are being provided, and to keep in mind that many social and personal care models are very appropriate for some patient populations. These might be people who need personal care, assistance with activities of daily living (ADLs), meal preparation, and other important tasks that make the difference in remaining safely at home.

The care and models discussed in this chapter can range from someone coming into a home to assist with this needed personal care, such as helping patients take a bath or providing assistance with dressing, to very skilled levels of care with credentialed, licensed nurses where the patient’s home looks like a room in an ICU, complete with a ventilator, oxygen, monitors, alarms, intravenous “drips,” complex medication regimens, and more.

This wide and sometimes confusing variation can be difficult for consumers of home care, such as family members seeking care for a loved one, to understand and navigate. This is part of the reason that “home care” does not mean just one thing and may be viewed as having more than one voice. There are many voices and models. For purposes of this book, the broadest definition of home care (and most understandable for clarity) will be used: “Any kind of healthcare provided at home.” This definition then includes the myriad and far-reaching types of services provided in a patient’s home. It may also work for care models and innovations that we do not even have right now! Let’s see what some of these home care services “look” like.


This chapter starts by covering Medicare only because of the sheer volume of care provided and the dollars spent there. Some readers may know that after I had been a visiting nurse and a home care and hospice manager for some years, I also worked for four years at the Health Care Financing Administration (HCFA) central office, which became the Centers for Medicare & Medicaid Services (CMS).

Medicare is the largest health insurance program in the United States (and one of the largest in the world). As such, it is also the largest payer of home care and hospice services in the United States (Leonard, 2015). As with all medical insurance programs, ...

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