Agencies' perceptions of factors affecting home care referral

Issues and opportunities in the regulation of home health care

Recent federal legislation established a Certificate of Need (CON) process by which health care providers must receive state approval before building or renovating a facility, or adding a new service. Certainly, strict regulation of cost and quality of home health care is needed, but it is asserted that CON is an ineffective way of organizing the delivery of services and limiting costs, and furthermore, that CON is biased in favor of institutionally-based providers and maintenance of the status quo. The authors feel that vested interests have a history of trying to use earlier state CON regulations to control their turf, limit competition, and consequently stifle innovation. Home health care should be incorporated into national health planning goals and integrated into state and regional health plans. Such planning must precede CON regulations and should not be confused with it. Alternatives to CON can achieve quality service and moderate costs and include licensing of personnel, standards for provider accreditation, and utilization review. Planning for these alternatives should begin now to avoid fragmented expansion of home health care. Evidence suggests a comprehensive use of home health care as a cost-effective alternative for many levels of care given in hospitals and nursing homes.

The future of home health agencies

A multidisciplinary, multi-institutional, volunteer task force was convened by the Visiting Nurse Association (VNA) of Los Angeles to perform an evaluation of the agency and, on the basis of the evaluation, to make recommendations regarding the future potential of home health service agencies in the United States. For the VNA of Los Angeles, this use of a voluntary task force as a planning mechanism was successful; we strongly recommend its application to other agencies. The recommendations made were specific to the VNA of Los Angeles, but many are applicable to home health agencies in general. They called for an expansion of the types of services currently offered, with an emphasis on the coordinated team approach to health problems, an increased emphasis on preventive and health education services, and a movement toward providing services to groups as well as individual home care patients. The task force also urged willingness to expand services to include primary care. Modern management techniques were recommended as tools to increase the efficiency of home health service agencies. Potential new sources of revenue were proposed.