The provision of health care services in patients’ homes has grown exponentially over the past two decades. Originally, home care services were provided mostly by local not-for-profit agencies. Home care today has grown into a highly competitive multi-billion-dollar sector with both for-profit and not-for-profit providers. This column will discuss the various types of home health care services and the agencies that provide them in New York.

Background

The history of home health care services in New York is inextricably tied to pioneering women such as Lillian Wald, who founded the Henry Street Settlement in Manhattan, and what later became the Visiting Nurse Service of New York in the late 19th Century. The concept was replicated and more of these organizations were set up as community-based providers of basic nursing care. With some government but mostly philanthropic support, they were established primarily to assist the poor and elderly in the days before there was health insurance and a social safety net with government health benefit programs. Over time, home health evolved to include a variety of levels of care, whether the patients were covered by health insurance or not, and whether they needed care after being discharged from a hospital, ongoing care for a chronic medical condition, or simply help with the activities of daily living such as feeding, bathing and housekeeping.