House Joint Resolution No. 33 was passed by the 1978 session of the General Assembly. It requested the State Department of Health and the State Department of Welfare to establish a joint task force to study the feasibility of creating a joint homemaker-home health aide position and to investigate potential reimbursement sources for the services provided by the position.

The Departments of Health and Welfare carried out the required study with the assistance of an Advisory Task Force, whose members included central, regional and local health and welfare personnel, staff members of related State and advocacy agencies, and representatives of proprietary and private non-profit agencies.

The study determined that significant growth in the provision of joint homemaker-home health aide services had occurred through the country during the past twenty years. Encouraged by the National Council for Homemaker-Home Health Aide Services, Inc. and funding mechanisms such as Titles XVIII, XIX and XX of the Social Security Act, the number of aides has increased from 1,500 in 1958 to 82,000 in 1978. While local home health and social services in Virginia have increased dramatically in recent years, the availability of joint homemaker-home health aide services remain limited.

The Medicaid and Medicare programs are funded by Titles XIX and XVIII of the Social Security Act, respectively. For the categorically needy, those who receive public assistance, and the medically needy, those whose income exceeds public assistance eligibility but is insufficient to meet medical costs, the Medicaid program in Virginia includes home health care. By law Medicare home health care benefits are skilled care or rehabilitation oriented. To be eligible for such benefits, a person must be homebound, under the care of a physician and need part-time or intermittent skilled nursing service and/or physical or speech therapy. In contrast, Medicaid home health care benefits do not require skilled nursing care or physical or speech therapy. Home health aide services funded through either program include personal care duties (exercise, medications, bathing) and incidental household services (light cleaning and laundry, food preparation) which do not substantially increa.se the time spent by the home health aide.

Title XX of the Social Security Act also funds the provision of many social services related to homemaker-home health aides. In Virginia, Title XX funds are allocated to 117 geographic areas which, based upon local needs assessment, determine the social services to be provided the citizens. The twenty-nine potential services may be delivered directly through local departments of public welfare or purchased from other agencies. One purchased service, through a contract between the State Health and Welfare Departments, is home health services, including home health aide services, provided by local departments of public health to homebound patients who are Title XX eligible but not Medicare or Medicaid eligible. Other home-based services funded through Title XX which relate to the types of services provided by a homemaker-home health aide are homemaker, chore and companion services. They are optional services which are delivered by local welfare agencies as well as purchased from voluntary non-profit and private providers.

Homemaker-home health aide services assist the aged, the chronically ill, the person convalescing at home, the physically handicapped, the mentally ill and those who are socially incapacitated to sustain, attain or regain maximum self reliance in his own home and to enhance the quality of daily life. Duties under the supervision of a nurse or other appropriate professional person include both home management and personal care, such as bathing, rehabilitative services, meal planning and preparation, assistance with oral medications and essential household tasks. When combined, the joint services of a homemaker-home health aide can prevent individuals and families receiving the two separate services from different individuals and can save significant costs to the agencies involved through the elimination of duplication of effort.

The provision of homemaker-home health aide services is dependent upon the availability of individuals trained to provide the service and funding mechanisms to pay for it. The study determined that such services can be provided through many types of agencies -- public, voluntary non-profit, proprietary, private non-profit and other combinations -- some of which have staff currently capable of providing the service in Virginia. Training of staff is important and the State Department of Health recently received approval of a federal grant to develop an operational model for statewide home health aide education. The basic national standards for homemaker-home health aide services developed by the National Council are designed to provide adequate safeguards for consumers, third-party payers and service providers.

Funding mechanisms available for homemaker-home health aide services depend upon the agency providing the service, client resources and program eligibility, and the level of service needed. Depending upon these factors, the joint service can be funded partially or entirely by the client, private insurance, Medicaid, Medicare and Title XX, or combinations thereof.

To facilitate the development and utilization of homemaker-home health aides in the Commonwealth, the Department of Health and the Department of Welfare make the following recommendations:

1. The position of homemaker-home health aide should be created to provide personal care and household services essential to health care and health-related services to homebound individuals.

2. The State Department of Personnel and Training, working cooperatively with staff of the State Departments of Health and Welfare and other appropriate persons, including the private sector, should develop a job description, job requirements and training for the position of homemaker-home health aide.

3 The Virginia Office on Aging should take the lead in coordinating Virginia's efforts in support of the development of a sound State and national policy which would consolidate home health and in-home service programs.

4. Local welfare departments, which provide homemaker services, and local health departments, which provide home health aide services, should work closely together to ensure that cases requiring both homemaker and home health care receive homemaker-home health aide services from a single individual whenever possible.

5. Staff of local welfare departments who provide direct homemaker services and who meet the job requirements of the position of homemaker-home health aide should be given priority to participate in the nursing project for the training of homemaker-home health aides.

6. In the Virginia Title XX Comprehensive Social Service Plan for the fiscal year ending June 30, 1981, homemaker service should be expanded to include home health services and homemaker-home health aide services and consideration should be given to make such service mandatory in all localities.

7. Non-profit, voluntary and public certified home health agencies should consider subcontracting with proprietary home health agencies as one alternative means of expanding services without hiring additional staff.