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Home Healthcare


Home healthcare incorporates all the health related services a person accesses from home including but not limited to nursing care (skilled). Some of the personell deemed fit to provide home healthcare services include but are not limited to registered nurses, therapists, homecare aides etc. Home healthcare which is accessible to all Medicare beneficiaries is directed towards treating a given condition, injury or illness. With quite a number of individual retiring from active employment, we have in the recent past seen a sustained increase in the number of those who desire to receive treatment in the comfort of their homes. The various reasons presented for this trend include the desire by the elderly to receive care as well as treatment in a place they are already accustomed to as well as the convenience they foresee when it comes to receiving health services from the comfort of their own homes. This coupled with the projections that indicate that thousands of baby boomers will be retiring from active service calls for drastic steps to be taken for purposes of enhancing the efficiency of the home healthcare services. In this text, I concern myself with the home healthcare in Texas.  The main target population in this case shall be the all those eligible for Medicare. A study of the home healthcare in Texas is critical so as to assist those who are charged with the formulation of policies put measures in place for purposes of ensuring that the retiring population whose numbers is projected to be on the increase is well catered for when their time comes to access the home healthcare services.

The conclusions derived herein shall also be critical for players in the home healthcare marketplace as they can use the projections and discussions to come up wit working plans for purposes of enhancing the effectiveness as well as efficiency of the Texas home healthcare system. It has been noted in some quarters that today, people all over the world are living longer. This is in sharp contrast to a decade ago. However, there has been a sustained increase in the number of health issues reported meaning that as the mortality rates go down, health complications seem to be on the increase. With this in mind, there is a great need for providers of home healthcare services to have a detailed understanding of the situation on the ground as far as home healthcare and other related demographics are concerned not only in Texas but in other states as well. As at now, the policy makers do not have adequate information reflecting the situation on the ground as far home healthcare is concerned. This is not the situation in Texas alone but in a number of other states as well. The existing number of home healthcare organizations in Texas is not adequate to handle the projected increase in the number of retirees in the coming seven years and hence there is great need for investors interested in the home healthcare marketplace to strategies on how to fully exploit the opportunities offered by the home healthcare market in Texas going forward.  

 Literature review

According to Harria (2009), the US home healthcare marketplace comprises of close to 23000 establishments. In Texas alone, we have close to 215 establishments offering healthcare. However, most of these establishments are branches of companies considered to be multi-location. It is important to note that in Texas, just like in other states, the demand for home healthcare is driven by a number of things which include but are not limited to the preferences of patients when it comes to home healthcare, the technological advancements as far as portable medical equipment is concerned and lastly the demographics. Currently, most of the players in the Texas home healthcare marketplace are small companies and this has raised issues as regards fragmentation. The high fragmentation according to Martinson (2002) affects the competitiveness of such companies and their survival is anchored on operations efficiency as well as effective marketing. However, large companies operating in the home healthcare marketplace in Texas still have an advantage over small companies due to their economies of scale when it comes to marketing and/or sales.

Information sourced from Rice (2006) show that currently, most of the services as far as home healthcare in Texas is concerned include home nursing care, home hospice care and lastly the traditional home care which accounts for a large chunk of the market standing at 56%.In a report carried out by Modin et al. (2002) and titled Care by general practitioners and district nurses of patients receiving home nursing: a study from suburban Stockholm, it was found out that most of the companies offering home healthcare in Texas tend to neglect some conditions while giving much prominence to some. The report comes up with some interesting findings which can be adopted by policymakers to rectify the situation.Another study carried out by Lotus et al. (2002) and titled Predictors of nursing home placement and home nursing services utilization by elderly patients after hospital discharge found out that there is a shortage of companies which offer coverage of home healthcare which require long term treatment and care. Although this study focused on the Texas home healthcare market place, another5 study by Riccio (2001) titled Quality Evaluation of Home Nursing Care: Perceptions of Patients, Physicians, and Nurses reinforces this findings by noting that that the dismal coverage long term treatment receives in the US needs to be addressed as a matter of urgency.

The study by Lotus et al. (2002) in Texas alone, conditions such as Chronic obstructive disease (COPD) which demand long term attention as well as treatment is on the increase. Figures presented by the Texas Health Services Authority (THSA) estimate that close to 1000 people in Texas alone could be suffering from the disease and these figures could increase. However, the current fragmentation of the home healthcare companies in the Texas home healthcare market hamper the provision of long-term care because of their inability to handle such services. Therefore, such services are left to big players who can’t satisfy the demand for services relating to long-term treatment like chronic obstructive disease (COPD) which is on the increase in Texas.When it comes to the most prevalent admission diagnoses for patients as far as home healthcare is concerned in Texas, a study carried out by Butler (2005), and titled home healthcare in America today found out that some of the most common admission cases include diabetes, heart disease as well as cerebral vascular disease. Another study titled Lakatos (2009) which was carried out by Home healthcare marketplace indicated that a majority of those seeking home healthcare services in Texas, actually 70%, were aged 65 years and above.Harria (2009) notes that with the majority of baby boomers beginning to retire in the next seven years, it remains to be seen if policy makers will rise to the occasion and make the Texas healthcare market place more vibrant as well as competitive. For instance, Lotus et al. (2002) notes that asking players in the home healthcare market to merge to minimize the current stratification shall be a good starting point.

  Purpose of the study

  1. To identify some of the issues that hampers the treatment as well as coverage of conditions requiring long term treatment e.g. chronic obstructive disease (COPD).
  2. To identify what needs to be done to address the prevailing fragmentation of home healthcare companies in Texas.
  3. To outline issues as well as demographics that policy makers need to be aware of so as to address the projected increase in the number of baby boomers retiring in the next seven years and who will at some point require home healthcare.
  4. To identify measures that need to be taken to enhance the quality of services offered by players in the home healthcare marketplace.
  5. To avail pertinent information to policy makers on the situation on the ground so as to come up with more responsive policies.  


Data sources

The study concerns itself mainly with home individuals who are aged above 65 years of age. Also taken into consideration are companies offering home healthcare in Texas. The information availed by the Texas Health Services Authority (THSA) was used to come up with the number of individuals accessing home healthcare. This report also estimates that those currently accessing healthcare in Texas are approximately 665000. In percentage, this can be taken to be 26% of the entire population.As stated earlier, data estimates from the Texas Health Services Authority (THSA) show that a majority of those accessing home healthcare are aged 75 years and above. Files in procession of Texas Health Services Authority (THSA) were used to determine the gender, age as well as disease classification of those who accessed home healthcare for the period between May 2002 and May 2009.Texas Health Services Authority (THSA) was the main source of information when it comes to companies operating in the Texas healthcare market. This information included but was not limited to accreditation records, patient records as well as market share records.

 Analysis and design

For purposes of data linkage as well as computation and processing, Microsoft SQL Server- 2009 version (Microsoft, Redmond, WA, USA), which is a database software, was utilized. Descriptive statistics utilized or used for purposes of the results presentation.Before settling on research design, a number of factors were taken into consideration. Some of the factors that were considered included the kind of information that was required as well as the cost of the design. The nature of the study was also taken into consideration i.e. the feasibility of data collection and the reliability as well as validity of data collected. After a detailed consideration of all he above factors, it was decided that a descriptive research design would be utilized.  A descriptive research design was most appropriate as what was needed in this study was a detailed explanation of a given behavior as opposed to seeking given relationships or correlation between a given number of variables.This research design helped in the acquisition of a substantial amount of information through description. The information which was obtained in this case could be easily subjected to an investigation by way of other means. The results of a study using a descriptive design however cannot help in the identification of a cause since all the variables are present.  It is also important to note that it was possible to obtain quite a substantial amount of information primarily by use of description. This research design also comes in handy as far as variable and hypothetical construct identification is concerned.

However, it is often relatively difficult to identify causes because of the design’s natural setting, which means all the variables will be present.When it comes to informed consent, it is important to note that the study followed all the provisions as far as informed consent is concerned. Among the issues to that were addressed as far as informed consent is concerned was the selection process as well as confidentiality. A consent form was prepared and all the respondents who were questions were required to fill the form. For purposes of respecting as well as protecting individual rights, there is need to give special attention to informed consent. Great care was also taken in the preparation of a form that took into consideration al he elements laid down by IRB. More attention was given to the preparation of these forms to make them understandable even to individuals with low literacy levels. It is also important to note that great efforts were employed to ensure that all the opinions of participants as regards informed consent were taken into consideration so as to inform any changes that may be needed on materials.Lastly, it is important to note that all the participants were informed in a clear as well as precise way on the purpose, duration as well as procedures that were to be applied when it came to the research. They were also informed of their right to or not to participate in the study.

 Study limitations

The first limitation of the study had to do with the extent to which information could be sourced. At times, it was increasingly difficult to access some information as regards demographic or other wise. Similarly, some of the companies in the healthcare market place were not forthcoming with important data for fear of such data finding its way to competitors and being used against them. When faced with such constraints, forecast were at times obtained based on estimates from historical data.The second limitation was resources. For lack of adequate resources, the study could not incorporate extensive data from a wide variety of sources. Attempts were however made to cut costs by using journals as well as other easily available sources. The study was also limited to Texas. It would have been desirable to carry out a wholesome study of a number of states so as to compare and contrast the various results regarding the home healthcare industry in relation to Texas, our central area of study.


Harria, M. (2009). Handbook of Home Health Care. Jones & Bartlett Learning

Kitchener, Ng & Harrington, 2003. Medicaid HCBS Program Data. SF: UCSF

Lotus Shyu, Yea-Ing; Hsiao-Chin Lee (2002). Predictors of nursing home placement and home nursing services utilization by elderly patients after hospital discharge. Journal of Advanced Nursing 38 (4): 398–406.

Martinson, I.M. (2002). Home health care nursing. Elsevier Health Sciences

Modin, S.; A. K. Furhoff (2002). Care by general practitioners and district nurses of patients receiving home nursing: a study from suburban Stockholm. Scandinavian Journal of Primary Health Care 20 (4): 208–212(5).

Riccio, Patricia A (2001). "Quality Evaluation of Home Nursing Care: Perceptions of Patients, Physicians, and Nurses". Journal of Nursing Care Quality 15 (2): 58–67.

Rice, R. (2006). Home care nursing practice: concepts and application. Elsevier Health Sciences

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