Home health care: The patient-care profession that comes to you

They're the ones who tend to your loved ones when you can't. They check to see if medications have been taken, they see if progress has been made, they dress bandages and in some cases they might even do some housekeeping.

“A lot of people think just seniors get home health care,” Julie Knake Tow said. “But a client could be a child going through cancer treatment or a child who has physical disabilities.”

Tow is administrator and owner of Comfort Care Medicare Inc., which provides services that include skilled nursing, physical therapy, speech therapy, occupational therapy, home health aide and homemaker.

About 75 percent of Comfort Care's clients plan to have long-term home health care, versus about 25 percent who need short-term care such as intravenous therapy. Comfort Care offers services at a minimum of one hour, rather than the typical three to four hours required by some agencies, Tow said.

Approximately three-quarters of Tow's employees are full time - 25 percent are nurses and other health care professionals, 50 percent are private home health aides and 25 percent are support staff, such as payroll and billing.

“We can actually train our own home health care aides. They don't have to have any experience,” Tow said.

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People are opting more for home care, as opposed to staying in a facility, thanks in part to community education, said Jennie Fisher, executive director of ResCare HomeCare of Iowa, based in Cedar Rapids.

The majority of referrals come from hospitals, community case management workers, nursing homes and physicians.

The majority of the clients are truly long-term, from pediatric to geriatric. Often people remain ResCare clients for many years, Fisher said.

About 60 percent of the services ResCare HomeCare of Iowa provides are medical, versus 40 percent non-medical, such as homemaking and personal assistance.

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ResCare does offer an option for live-in care, but for less costly 24/7 monitoring, the company has an optional remote web-based care - or telecare - system. Sensors and monitors can be installed per request, such as keeping tabs on when a client gets in and out of bed or if they open a specific door. There are also pop-up reminders such as when to take medications.

“It can be really client specific and built to what the client needs,” Fisher said.

Some companies offer home care as part of a suite of health care services, said Shannon Davis, communications and media specialist for CarePro Home Health, a division of CarePro Health Services.

CarePro Home Health staff are able to coordinate with patient needs such as infusion therapy, medication delivery and medical equipment, Davis said.

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Iowa is one of only eight states that allow anyone to open a home care business, even those without a nursing background, Tow said. Non-Medicare certified agencies don't have to be state certified and aren't regulated, Tow said.

Home health providers work with a variety of funding sources, which can include Medicare and Medicaid, worker's compensation, Title 19, Medicaid Waiver Programs, veterans' programs and private insurance companies, Fisher said. ResCare is a national company that also has national contracts with larger insurance companies.

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Federal and state guidelines set the standards for home health agencies for Medicare and Medicaid certification. Included are background checks, initial training and ongoing in-service training requirements.