The first home health aides were women hired to care for the homes and children of mothers who were sick or hospitalized in the early 1900s. During the Great Depression in the 1930s, women were hired as “housekeeping aides.” They were paid by the government. When this government program was discontinued, some aides continued to work for local family and children’s services, which provided services to families in need.
In 1959, a national conference on homemaker services was held. It was clear that there was a great need not only for homemaker or housekeeping services, but also for personal, in-home care of sick people. Thus, the aide’s role expanded to include personal care of the sick as well as care of the home and family.
In 1965, the Medicare program was created. Because many Medicare recipients need home care, home health services have been growing ever since. Medicare first began referring to homemakers as “home health aides.”
Interest in home health care has increased for several reasons. Increased healthcare costs along with advances in capabilities have created a need for the affordable, continuing care that home care provides. T he growing population of the elderly and people with chronic diseases, such as AIDS and Alzheimer’s disease, has also created greater demand for home care.
Another reason home health care has grown is the use of diagnostic related groups (DRGs) by Medicare and Medicaid. A DRG specifies the treatment cost Medicare or Medicaid will pay for various diagnoses, or physicians’ determinations of an illness. Because a flat fee is assigned for each diagnosis, hospitals lose money if a person’s stay is longer than what is allotted in the DRG. Hospitals generally make money if a person’s treatment is completed more quickly than specified in the DRG. Home health care has grown to take care of the needs of people who are discharged from the hospital earlier than they would have been in the past.
Today, the process of training and monitoring home health aides is changing. Many states are developing certification standards for programs that train aides. The Centers for Medicare & Medicaid Services, formerly the Health Care Finance Administration (HCFA), is a federal agency within the U.S. Department of Health and Human Services. CMS runs the Medicare and Medicaid programs at the federal level. In 1999, CMS issued new rules for home health agencies that care for Medicare clients. These rules include criminal background checks for newly hired aides, and they allow certified nursing assistants to work as home health aides.