Contempo Updates
Clinician's Corner
September 3, 2003

Home Care

Author Affiliations

Author Affiliations: Department of Medicine, Boston University School of Medicine, Boston, Mass (Dr Levine); Departments of Medicine and Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY (Dr Boal); and Department of Medicine, Virginia Commonwealth University, Richmond (Dr Boling).


Contempo Updates Section Editor: Sarah Pressman Lovinger, MD, Fishbein Fellow.

JAMA. 2003;290(9):1203-1207. doi:10.1001/jama.290.9.1203

Care at home is an important option for patients with acute or chronic health problems.1 Home care used appropriately decreases hospitalization and nursing home use without compromising medical outcomes. Moreover, patients generally prefer to remain in familiar surroundings. Physician support of home care services honors that preference.

The term home care refers to any diagnostic, therapeutic, or social support service provided at home (Box) .2 Home health agency care is familiar to most physicians. Quiz Ref IDThis includes physical, occupational and speech therapy, skilled nursing, social work, and home health aide services; is focused primarily on postacute care; and usually lasts weeks to months. Home care also encompasses the use of medical equipment, telemedicine monitoring, and portable diagnostic tools. Technologically intensive services range from simple intravenous therapy to multidrug preloaded infusion pumps, hemodialysis, and ventilators. The specialized hospice benefit is another important home-based service. Long-term supportive care is provided mainly by personal care aides and lay caregivers. Payers and regulations vary (Table 1).35 Home medical care involves a physician, physician assistant, or nurse practitioner who provides acute or chronic care, which can be preventive, diagnostic, therapeutic, palliative, or rehabilitative.

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