The past, present, and future of skilled home health agency care.

This article reviews the past history of home health agency care from its beginnings to the present day, evidence regarding the effect of recent changes in financing on these services, the state of skilled home health care in 2008, and a discussion of future directions. Home health care serves several million patients per year, many of whom are recuperating from acute illness episodes. Due to illness burden and Medicare funding, a large proportion of care that home health agencies deliver is geriatric care. However, home health care plays an important role for patients of all ages with significant acute and chronic illnesses. Medicare home health care suffered a significant downturn following the 1997 Balanced Budget Act and is recovering under Prospective Payment. Like most sectors of care, home health care has often operated in a "silo" but there is increasing recognition of the need to bridge care settings and provide care continuity for sick, chronically ill individuals. This is an important challenge for the future. Agencies that have strong information technology infrastructure and chronic care management systems along with a seasoned clinical workforce will be well positioned for key roles in home health care in decades to come. Home health care serves several million patients each year, many of whom are recuperating from acute illness episodes. Due to the burden of illness and Medicare funding, a large proportion of care that home health agencies deliver is geriatric care. However, home health care plays an important role for patients of all ages with significant acute and chronic illnesses. Medicare home health care suffered a significant downturn following the 1997 Balanced Budget Act (BBA) and is recovering under prospective payment. Like most sectors of care, home health care has often operated in a "silo," but there is increasing recognition of the need to bridge care settings and provide care continuity for sick, chronically ill individuals. This is an important challenge for the future. Agencies that have strong information technology infrastructure and chronic care management systems along with a seasoned clinical workforce will be well positioned for key roles in home health care in the decades to come.