Home Care

Historical Perspective of Home Care

Throughout most of history, medical care was primarily provided to individuals within their homes, either by family members or various health care practitioners. In the United States, formal home care services date back more than 200 years, when in 1796 the Boston Dispensary began providing in-home medical services as an alternative to institutionalized hospital care, which was utilized mostly by the poor and viewed as stigmatizing. The modern concept of home care grew as an industry during the second half of the 19th century as an increasing number of agencies provided health and support services in the home and the fields of social work and visiting nursing professionalized.

In the early to mid-1900s, the delivery of medical services shifted from the home to institutional settings, with an emphasis on hospital and nursing home care. This resulted in a growing number of individuals with chronic medical conditions and/or disabilities being placed in institutional settings. By the 1950s, criticisms of the efficiency and quality of nursing home care emerged, raising questions on the appropriateness of institutional settings for nonacute care. Demand for noninstitutional models of care intensified as the disability rights movement gained momentum, which unified individuals with disabilities and vocalized consumer preference to receive health and supportive services in home and community-based settings. In 1965, the federal government responded to demand for home-based care through the reauthorization of the Social Security Act, which included provisions for home care in the newly established Medicare and Medicaid programs.

[Page 279]In the decades to follow, there were a series of policy responses that expanded access to home care. The Omnibus Budget Reconciliation Act (OBRA) of 1980 and the 1988 Duggan v. Bowen court decision are examples of policies that broadened the eligibility for Medicaid and Medicare recipients to receive home care benefits. The concept of home care was further supported through the U.S. Supreme Court Olmstead decision in 1999, which required states to offer individuals with disabilities services in the least-restrictive setting.

...