How will the changes occurring within healthcare in the United States affect home healthcare? Demographic shifts, emerging technologies, and a changing perspective on healthcare delivery models will create challenges and opportunities. The major factor affecting the future of home healthcare is the aging of the baby boomer generation. According to the AARP (2014), in 2011, the first of the baby boomers started turning 65 years of age at a rate of 8,000 per day-a pace that will continue until 2029. By 2025, the number of people older than 65 years is expected to grow to nearly 72 million (Chicago Sun Times, 2014). By 2050, seniors will number 83.7 million or 21% of the U.S. population (U.S. Census, 2014). An increase in the aged population will mean an increase in healthcare needs, especially treatment for expensive chronic diseases. Managing chronic diseases currently accounts for 75% of U.S. healthcare spending (Home Health Care News, 2012), costing $510 billion in 2004, and is expected to be more than $1 trillion in 2020 (Outcome Concept Systems, 2004). If current trends continue, total healthcare spending will be 20% of the gross domestic product (GDP) by 2015 and 30% of GDP by 2050.
An aging population will put more strain on the Medicare budget. In 2012, Medicare provided coverage to 50.7 million seniors, costing $590.8 billion. It is estimated that 78.0 million people will be covered in 2030 (Plunkett Research, 2014). Budget constraints on Medicare will result in less reimbursement. A trend that can possibly solve this problem is the disease-management delivery model, a shift away from treating episodes of acute exacerbation of chronic disease and a movement toward prevention through evidence-based practice guidelines and patient empowerment strategies. The move from treatment to proactive monitoring to manage chronic diseases can help achieve the goal of keeping many more people healthy and out of hospitals (Outcome Concept Systems, 2004).
Home healthcare can provide management of chronic illnesses more cost effectively than hospitals or nursing homes. In 2012, the average Medicare cost for home healthcare was $44 a day, compared to $559 a day for nursing homes and $1932 a day for hospitalization (Home Health Care News, 2012). However, the aging population is increasing faster than the human resources needed for healthcare. The American Association of Colleges of Nursing (AACN, 2014) projects that there will be a nursing shortage of 260,000 registered nurses (RNs) by 2025 and the Association of American Medical Colleges (AAMC, n.d.) predicts a shortage of over 91,500 physicians by 2020 and 130,600 by the year 2025.
Telehealth will be increasingly used to solve the problem of baby boomers' demand for healthcare outpacing human resources. Patients will answer daily health assessment questions on a self-contained computer with touchscreen monitor (i.e., a tablet computer). Devices such as blood pressure cuffs and pulse oximeters can be attached to take measurements. The results will be transmitted to secure Web sites where RNs can review them and instantly contact the patient and primary care provider if the data indicate a decline in health (Penn Live, 2011).
Currently all medical records are being transferred into electronic form, which is necessary for successful implementation of telehealth. Accelerating this trend is the 2014-2015 deadline of the Federal Electronic Records Mandate contained within the American Recovery and Reinvestment Act, legislation that provides funding and incentives to all healthcare organizations, including home healthcare, to adopt electronic medical records (EMR). Part of the incentives are penalties levied on organizations who have not adopted EMR use, 1% in 2015 and 5% every year afterward, mostly in the form of reduced Medicare and Medicaid reimbursements. The use of EMR by home healthcare organizations is expected to be near 100% by 2020 (My EMR, 2011).
The increasing complexity of caring for patients with chronic diseases will demand that home healthcare nurses be educated minimally at the bachelor's degree level. Not only will they be called upon to manage patients with chronic disease, they will need to be adept at leading patients toward healthy lifestyle changes. A 2010 Institute of Medicine (IOM) report recommended that the proportion of nurses with baccalaureate degrees increase to 80% by 2020 (IOM, 2010).
Eighty-nine percent of today's seniors say they want to stay in their homes as long as physically possible. To honor their wishes they will need medical professionals who are skilled in chronic disease management. They will also need the support of informal caregivers. By 2050, the ratio of possible caregivers to family members needing care will be 4 family members to 1 senior, down from 11 family members to 1 senior in 1990 (Franchise Help, 2014). There will also be a tremendous need for home health aides. The U.S. Bureau of Labor Statistics (2014) predicts a 48% increase in the demand for home health aids between 2012 and 2022.
The adoption of electronic records will prepare home healthcare for the diffusion of telehealth devices necessary to fill in the gaps that the nursing shortage will cause. Higher education will be required by nurses to be able to perform with greater independence from the oversight of physicians, where a personnel shortage will also occur. If these developments converge in the proper sequence, the home healthcare delivery system of the present will transition smoothly into the model needed for the future.
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