*The concept of home health care can trace its roots to 1883 America as nurses would take care of the poor and sick in their homes. The concept soon transformed into a fast-growing industry and today over 15,000 companies in the United States provide home care services to 15 million patients (70% over age 65) resulting in a 58- billion- dollar revenue industry.

*Accredited home health agencies provide a wide range of services to all levels of Americans primarily for an illness or injury. The services can be minor like just “checking-in” and taking vital signs, reviewing diet and medication compliance, tips on self-care, homemaker services and personal care to more skilled services like wound care for pressure sores or a surgical wound, IV or nutrition therapy, injections, basic mobility (i.e. bed to wheelchair), feeding tube care, spine and brain injury, monitoring serious illness and rehabilitation. 

*Minor services are often provided by home care aides and registered nurses while skilled services are provided by skilled nurses, professional therapists, hospices, private duty nursing care and medical social workers.

*The majority of home health care is paid by Medicare whose policies generally set the guidelines for scope of services to be covered and reimbursement rates. Medicaid and private insurance often follow the lead of Medicare. In most cases, a doctor’s orders are needed to start care, a plan of care is created, and care is limited to 8-hours a day for up to 21 days of care. The home health agency staff is expected to help coordinate a patient’s care and to keep the appropriate health care providers and family members updated about the patient’s progress. Medicare does not cover 24-hour care, meals, homemaker’s services or custodial/ personal care that helps a patient with daily living if it’s not part of the established care plan.

*In general, the goal of traditional home health care is to provide less expensive care, more convenient, and just as effective care as one would get in a hospital or skilled nursing facility (SNF). When home health care services are effective, patients get better, regain their independence, become self-sufficient as possible and our healthcare system saves money.

*The home health industry continues to grow rapidly worldwide as seniors are living longer and the services are supported by health care providers, employers, Medicare/Medicaid and private insurance. Many experts predict a 7% annual growth rate for the industry, an increased use of technology to improve efficiency and clinical care and the need for 13 million new caregivers.

*Most of all home health care services provided to patients are deemed non-medical in nature and often deal with dressings, bathing. light cleaning, meal preparation and companionship. These are rarely covered by insurance and are provided by home care aides who earn on average $12.65 an hour or a median income of $25,280. The average cost for home health care services is between $21 to $25 an hour and full-time care or live-in support can cost a patient and their family an average of $5,000 a month. Bottom line: the economics of providing home health care services leads to high turnover (64% annually), increased costs for recruitment and training, challenges providing continuing care, challenges proving performance and constant pressure on home health companies to have enough supply to meet demand.


As with most areas of health care services which now accounts for 19% of our wealth, consolidation and a continuing reliance on for-profit medicine continues abated especially coming out of COVID. The home health care industry is no exception with 82% of companies being for-profit entities and the estimated demand for growth is attracting big investments from private equity companies and new franchise start-ups offering burned-out nurses and caretakers an opportunity to start their own businesses. 

The marketing pitch is that Americans have a thirst for flexible, independent living arrangements and that home health care can become more efficient and profitable through telehealth, mobile services, innovative monitoring services and the wise use of technology to improve field staff productivity. With their massive capital resources, the firms argue that they can best consolidate the industry to gain the scale needed to leverage referral services, attract staffing and maximize profit for their investors.

So while the pitch may play out well in urban America, what about rural America where patient needs are often more holistic in nature and travel costs can break the budget. When you talk to seniors in rural America, here’s what they tell us: if I have an acute illness, am recovering from surgery or experienced a serious injury, short-term home health care services can be very helpful especially if they are covered by Medicare or private insurance. But in my daily day-by-day needs for living independently with dignity, I need help with:

*Managing household tasks, ensuring that I eat healthy and that I am paying my bills

*Ensuring that my home is equipped with safety measures to prevent injury and I have help with needed home repairs

*Companionship and helping to ensure that I remain part of my community. Isolation leads to loneliness and bad outcomes 

*Personal care such as bathing, education on self-care and professional help when needed

*Getting to health care visits, picking-up my medications, shopping and access to a trusted professional when I’m scared or don’t know where to turn.

*Access to a trusted care manager to help coordinate and manage my health care conditions, my emotional needs, my medication compliance, my memory losses and to help me navigate acute challenges/emergencies, surgeries and rehabilitation when needed.

At Wellness Rx, we hear the voices of our local seniors and are working on cost-effective solutions that a local Wellness Center embedded into the community can provide. A local Wellness Center knows and cares about their patients. It is the ideal location for incorporating care professionals and services into its structure to address the expressed needs of our seniors for living an independent life with dignity. Travel costs can be significantly reduced, efficiency maximized and care workers would also work within the Wellness Center to ensure full-time employment, team building, prevent burn-out and hopefully address the two burning challenges of home health care agencies: turn-over and staff recruitment. 

We enter 2023 full of hope and promise for a better tomorrow. Wellness Rx believes that non-profit medicine is “for the people” and leads to community-buy-in, sustainability and permanence. We must now expand our mission into home health care.