Changes in the education of health care professionals can help establish this new emphasis, said Judith Matthews. The focus of education in the past has been acute care, but that does not equip people to practice in a community setting.

Neil Charness called attention to the challenge very low population densities pose to home health care. Technology may provide a way to do virtual visits in such settings, but technology does not necessarily offer full access to a person’s home.

More than half of the older population lives alone, which highlights the need for supportive technologies that can help these individuals remain independent in their communities. In many cases, family members do not live nearby, exacerbating the problem of providing effective health care.

For caregivers who visit homes, these homes are their workplace, said Margaret Quinn. In addition, for many paraprofessionals, who are predominantly female and members of minority groups, their work and social positions are largely invisible in the larger society. Effective models of care recognize that home care is patient- and home-centered while simultaneously acknowledging the home as a workplace.

Committee member Daryle Jean Gardner-Bonneau observed that care recipients and care providers are part of a single system. Both groups will have a major effect on the way the system is designed and structured. The system needs to be flexible enough to enable a wide variety of choices by both care recipients and providers, and, she said, “I am not sure we always do that.”

COMMITTEE PERSPECTIVE

Wegman summarized some of the messages he heard at the workshop.

  • Better definitions can inform interdisciplinary analyses of home health care.

  • Funding practitioners and knowledge in separate silos restricts the construction of more comprehensive and coherent systems for the delivery of home health care.

  • Thinking longitudinally over the life course can help to meet the needs of care recipients in a home or community.

  • New approaches can improve education and training, ranging from specific training in the use of a device to general interdisciplinary professional education.

  • Care providers and care recipients always operate together as a dyad, and productive policy discussions will consider this dyad as a unit.



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