Physician Focus Home health care: What to consider

Dr. Robert Schreiber and Pat Kelleher

Our population is rapidly aging. By 2030, nearly 72 million people in the U.S. will be 65 or older. And not only are we aging faster, we're also living longer: A report just released by the Centers for Disease Control charted U.S. life expectancy in excess of 78 years, the highest it's ever been.

Additionally, chronic diseases, such as diabetes, arthritis and Alzheimer's, are affecting more and more people. Whatever the medical condition, whatever one's age, however frail one may be, the desire remains strong to stay in one's home, living as independently as possible. Home care may provide some help.

Currently, about 8 million Americans require some kind of medical care in the home, a number that will jump dramatically as people live longer, want to stay at home avoiding nursing homes or other living arrangements, and pressure mounts to control soaring health care costs. If you've thought of home care for yourself or a loved one, here are some things to consider.

Start by observing

Sometimes people don't realize that their parents or elderly family members can't do the things they once did. Look for warning signs. Is mom or dad having memory or vision problems, trouble walking or taking many medications? Is the person having difficulty with the normal activities of daily life? If the answer to any of those is yes, it may be time to proceed.

Speak up

When you've identified the need for help, let someone know. Talk to the individual's physician about your concerns. Schedule a visit with all present and have an honest conversation. Many referrals to home care services first come from geriatricians or primary care doctors.

Get ready for objections

Mom or Dad may object at first to admitting a need for help or to having "a stranger" come into the home. Remember that family members caring for someone also need help, to get the things done that they need done while at the same time caring for a loved one.

Identify what you'll need

Home health care services are more complex and numerous than ever before. Will you need skilled assistance such as nursing or physical therapy? Help with meals and hygiene? Or just housekeeping activities? This is a critical step, as it determines not only what kinds of care the individual needs but also the cost of care.

Consult an expert

You needn't face these decisions alone. Professional home care agencies can assess needs, identify resources and develop individual care plans for a person's specific situation.

Allow care for the caregiver

Most home care -- up to 80 percent by some estimates -- is provided by family members, juggling work, the care of their own families and that of their parents or other family members. Caregivers often become burned out and don't realize it. If the primary caregiver gets sick and there's no back-up plan, the system of care collapses. One of the key things to remember about home care is that it's not only taking care of the patient, it's also taking care of the caregiver.

A team effort is best

To do the best job for the patient, everyone involved must play key roles. It takes a team approach, with health professionals, home care aides, the family and the patient, so when something goes wrong, everyone can be alerted. Think of the patient and the family as the captains of the health care ship and the providers as the crew.

Oversee and advocate

Family members must remember to oversee the care that's given and to advocate for the patient. You want your family member to get the right care, and that comes from constant oversight and advocacy. If you see something you don't think is right, speak up and get it corrected. Remember: the patient and the family are the captains of the ship!

Many good sources of information on home health care are available online. To review Medicare-certified agencies, visit To connect to services for older adults and their families, visit Eldercare Locator at

Robert Schreiber, M.D., is a geriatrician and Physician-in-Chief of Hebrew Senior Life in Boston; Pat Kelleher is executive director of the Home Care Alliance of Massachusetts.

Readers should use their personal judgment when seeking medical care and should consult with their personal physician for treatment. Physician Focus is a public service of the Massachusetts Medical Society. You are welcome to email comments to