While making house calls may seem like an old-fashioned notion, the need for nurses, aides and other healthcare professionals to care for people in their homes is actually on the rise.

“Home care plays a very important and growing role in our country,” says Marcie Barnette, a former home care nurse who is now the director of education and credentialing for the National Association for Home Care and Hospice.

Home care is becoming increasingly popular, because it's more cost-effective than hospital and nursing home care, Barnette says, and many elderly and chronically ill people want to stay on familiar turf as long as possible.

Those who work in home care help recovering, disabled or chronically ill people who need medical treatment or assistance with activities like bathing, dressing and preparing meals. While many home care workers offer highly specialized services like podiatry or respiratory therapy, the greatest demand is currently for registered nurses and home health aides, Barnette says. According to the Bureau of Labor Statistics, 104,000 RNs worked in home care services in 2000, while 177,000 RNs will be needed in 2010. About 974,000 home health aides will be needed by 2014, up from the 624,000 aides working in homes in 2004.

A Call for Nurses and Aides

The home care industry is trying to find innovative ways to attract both nurses and home health aides to the field to meet this surging demand. Home health agencies traditionally required home care nurses to have a few years of hospital experience to prepare for the autonomy and decision-making skills necessary in home care. Due to the nursing shortage, some home care agencies are offering internships and preceptorships to woo recent nursing school graduates directly to home care.

Home health agencies are also getting creative in recruiting and retaining aides. Some agencies offer GED classes for workers who haven't completed high school, while others offer nursing school scholarships to aides who want to become RNs. In such cases, agencies benefit from “having a homegrown nurse who is loyal and understands home care from the bottom up,” Barnette says.

What It Takes

Home care is a good option for healthcare workers who have excellent critical-thinking and problem-solving skills, Barnette says. Home care professionals like nurses, social workers, and physical, occupational and speech therapists collaborate with physicians and serve as the physicians' eyes and ears in a patient's home. “Home care is a great opportunity to work one-on-one with patients in their own environments, and to teach them and their caregivers how to manage after you're no longer involved,” Barnette says. “You get to see a person become more knowledgeable, independent and functional because of your efforts.”

Medicare and Home Care

Despite the great fulfillment she found in the professional relationships she formed with her home care patients, Barnette notes that the field can be challenging and frustrating. Medicare's system of reimbursing home care agencies was revamped in recent years, causing a financial crunch that has changed the way home care workers operate. Since agencies are now paid on a per-episode rather than a per-visit basis, home care workers must limit their time with patients while still providing high levels of care, Barnette says. Home care nurses and other professionals must understand how “what they do clinically impacts the financial picture of the agency,” she says. Home care workers “can't just take care of patients anymore and really be effective. There is a great deal of responsibility and paperwork involved with managing cases.”

The fastest-growing segment of home care is personal care services, also called companion services, which aren't reimbursed by Medicare, Barnette says. A growing number of people are willing to pay out of pocket for help with their or their parents' cooking, cleaning, errands and other daily activities. Both personal care services and traditional home care services will continue to grow as Baby Boomers age and our population leads longer lives, experts say. “People can't go wrong by getting into home care if they think they would like it,” Barnette says.