The discussion centered on health care at home and what the current laws are governing the offering of home health care. There are several modalities that I can use to approach this problem. The two I have experience with are having a sick family member home receiving IV antibiotic therapy, and being a professional care giver at home for a patient with a complex medical situation.  

Receiving antibiotic therapy at home is possible if the insurance or healthcare provider approves in-home care.  Questions to ask and arrangements to make center around whether the insurance company provides home health nursing, or the patient has persons in their family with the needed skills to provide care. Other care is available in home, but is dependent on what the insurance covers and what is medically cleared to be done at home. This is a complex arrangement that many times involves the medical services provider (doctor or PA), the insurance company representative, and a social worker or patient advocate.   

As with many situations there is a medical provider (mostly MD, and sometimes a PA) that has to be responsible for the decisions and actions taken in the patient’s care. Many are reluctant to be responsible for such care as it is easier to administer care in either the Acute care (hospital) or long term care facility (nursing home or rehabilitation center). Easier as there will be other medical professionals available to take care of emergencies or other patient mishaps.  

Currently the patient can receive antibiotic therapy at home if a family member with the medical training can monitor the therapy or the patient becomes reasonably responsible to do it themselves. The materials are delivered to the home.  If a patient is caring for themselves, a home health nurse will check on them to see if the patient is managing their care correctly.  

Both management protocols require IV restarts at home or possibly a PICC line inserted before the patient leaves the hospital. IV restarts are recommended every 3 to 4 days and may occur more frequently if the IV catheter becomes dislodged. The person receiving the therapy needs to have the proper equipment place to hang the fluids (containing the antibiotics) and allow them the time to drip for proper treatment. Should a problem develop with the drip or vascular access devise, someone with the medical skills necessary to problem-solve the situation has to render the patient and/or family assistance to correct the situation. This can be as simple as finding the unreleased clamp to having to restart the IV.  

A restart of an IV can be easy or difficult depending on the patient and their unique illness and physical condition. Should a patient have a history of difficult vascular access, the recommendation should always be to have a PICC line placed prior to leaving a skilled medical facility for use in the home therapies. There are other possible vascular access devices, but that is another discussion.  

The other situation in which significant care can be delivered in home usually starts with a doctor offering a method to get the family member home and set up the home care that will be needed. This will require a significant amount of resources on the part of the family. Sometimes there are charity situations where medical professionals provide the home care, but the services are usually offered for short-term situations. Most professionals involved in home health care want to be compensated for services rendered. It is my experience this is negotiated beforehand.  

In the past, family members were sometimes trained to care for a patient in the home. With medical care becoming more complex and demanding higher skill sets, it is becoming an art that is beyond the layman who is not trained to provide medical care.  

The question posed by Ernest was if this was all legal? The above situations are legal when there is a medical provider (doctor or PA) who sets up and monitors the situations and provides the medical orders for all actions taken. Orders would cover deliveries of medical supplies to pharmaceuticals delivered to the home. Finding someone willing to set-up and monitor healthcare outside what is considered “legal” or beyond the scope of the insurance coverage is problematic.  Everyone currently licensed and doing anything outside the system is fraught with many perils if caught providing care that is not judged as “Good Samaritan” in nature. Again, this is a judgment call made by legal, medical, and state board personnel.  Not the patient or their families.   

But when discussing the future of healthcare, the ability to receive it may be the mechanism used to compel everyone in the US to comply with the government edicts. Already the pressure is there to have all doctors associated with either an HMO or hospital. There are Doctors in practices that are going bankrupt due to the changes brought about by Obama’s Healthcare Act.   

Under “Obama-Care”, there are provisions for local boards to set the standard and thereby make the decisions for who will receive what healthcare treatments. These boards making the decisions may or may not be made up of medical professionals.  Others may be accountants, lawyers, etc. making healthcare decisions about and for us.  They will judge if a patient (or you) are a productive or protected class member. Not you and your doctor. In my opinion, what will eventually be the case is if you are not producing babies or raising them for the state or a productive member of society (read military or high demand skill set), then you will be provided with a quiet room and medication (maybe) to assist you into that “long good night”. Of course this panel or group will be unassailable by any force that is not government approved under “Obama-Care” or future loop-hole filling legislation. 

Should this come to pass, the home healthcare as described above and provided by private insurance, Medicare, and Medicare supplement insurance with no longer be available to the segment of the population who will be requiring it the most �" the “Baby-Boomers”.  As this population ages and their medical needs manifest themselves, these “boards” will determine whether patient A will be granted the home healthcare needed vs. patient B.  A determination made upon criteria that reduces a human being to a list of standards and statistics allowing the government to manipulate our population growth and distribution �" based upon “productive member of society”.  

Should people decide “Obama-Care” isn’t the path they want to take for their healthcare needs, there are “Concierge Doctors”.  These are medical doctors who will see you in a professional manner, but it is strictly cash basis.  Some structure a yearly fee and additional fees for further care as needed. The advantages of the concierge medical practice is some of the “old school” medical services are provided.  Doctors may come to your home and do house calls when the patient is ill and also manage the home healthcare as described above.  Each concierge practice has a different fee structure and service menu.  The practice will work with the individual patient to determine what is needed on a case by case basis.  

There are locations where you can go and pay cash for surgeries. Surgical Center of Oklahoma comes to mind. Their web page  http://www.surgerycenterok.com/ can give more information than can be given here. More and more healthcare can be found functioning away from traditional centers like hospitals, and financial structures like insurance. Or to say it bluntly: red tape and the morass government reimbursement.