From Cottages to Condos

Abstract

The home health care industry has undergone a dramatic period of growth since the passage of Medicare (Title XVIII of the Social Security Act) in 1965. This growth has occurred in both the expansion of the total number of Medicare-certified agencies providing care, as well as the number of clients served and hours of care provided. It has been suggested that the single most important factor in this market expansion was the inclusion of a home care benefit in the original Medicare legislation, thus making it possible for nonprofit home care agencies to rely on a predictable source of government reimbursement. This paper explores the influence that amendments to the Medicare legislation since 1980 have had on market expansion, as well as other federal, state and private policy initiatives that have also influenced this growth. The authors suggest that overall growth does not equate with improved access or availability of needed services in the home for the frail and functionally-impaired elderly. Research findings from the first year of a three year study designed to document the impact of cost containment policies on community-based care for the elderly are reported in summary form to illustrate the authors position.