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INTRODUCTION

In 2011, an estimated 1 in 20 community-dwelling Medicare beneficiaries in the United States were completely or mostly homebound. This incidence will continue to rise as the number of individuals reaching older age outpaces mortality. As people age, they typically experience a higher burden of chronic diseases, symptoms, and functional limitations, all of which can contribute to homebound status.

Home-based care provides individuals who are chronically or temporarily homebound with access to a spectrum of services, including medical care. For some, home-based care may be the only way for homebound older adults to receive needed services and connect regularly with a medical provider. Home-based care can improve functional status, decrease hospitalizations, delay long-term institutionalization, and reduce mortality. It also provides unique opportunities for medical providers to assess functional capacity, social support, and safety in the home environment.

This chapter will provide an overview of the different types of home-based care available to a homebound individual. We will then describe two types of care in greater depth: home-based medical care and Medicare skilled home health care. These two complementary modes of care deliver medical provider and nursing services, respectively, to homebound individuals. We will then briefly discuss services that focus on social determinants of health or integrate medical and social services. We will conclude by reviewing new innovations and technologies advancing home-based care.

OVERVIEW OF HOME-BASED CARE

Modalities of care for older adults fall on a spectrum of increasingly specialized skills (Table 30–1). An individual may receive care through any number of these methods at a given time. Home-based care spans from informal and nontechnical to highly regulated and administered by certified professionals such as physicians, nurses, and therapists.

Table 30–1.Spectrum of home-based care.

Informal Care

The dedicated labor of millions of unpaid caregivers is the cornerstone of successful care for homebound individuals. Informal caregivers, the majority of whom are women, perform essential and challenging tasks, ...

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