Usually, a home health care for patients is indicated that need to be monitored need an adjustment of medications, change of clothes and a limited scope of physical therapy. Home care is often used after discharge from the hospital (post-acute care), although a hospital stay especially for the elderly is not a prerequisite home care can also be used in patients with diseases that many hospital days per year require (complex medical care) Medically stable patients with severe impairment (long term care) Sometimes patients with acute or chronic problems Sometimes patients who die (end-of-life care) Home care is increasingly being used to meet the demand for long term care. Home care, which can reduce the accommodation of patients in nursing homes by 23%, is less expensive than institutional care if home care workers and visits by qualified instructors are appropriately scheduled. Home care is provided by agencies, which differ with respect. Ownership, size, location and services. Some are certified. To certify an agency must meet state licensing requirements and federal conditions for inclusion in Medicare. Such agencies provide skilled nursing to under the direction of referring physicians. Nurses care services are offered under the supervision of a doctor who consults for necessary changes in care with them. Home care for patients requires communication between health professionals to ensure that patients receive their functioning and make progress as planned sure. Patients or caregivers must report on changes in the condition of the patient immediately to nurses or doctors to ensure that patients are monitored accordingly. Home care can medical and non-medical services offer (services that can be provided in home care). Services that can be provided in home care type Special services Medical Nursing Qualified professional and semi-professional care hospice services and respite programs Permanente medical equipment (eg. As commodes, wheelchairs, walkers) iv therapy Dialysis Parenteral and Enteral Nutrition respiratory support Diagnostic Procedures (z. B. X-ray, ECG, blood tests) non-Medical Personal care (z. B. help with bathing, hair washing, toileting and dressing) Cleaning P ersonal emergency notification systems alarm systems security monitoring food services (eg. As eating reimbursement Although most patients would like to stay with a serious chronic illness at home on wheels), can only afford a few full home care. While Medicare covers in patients who are domesticated bound, some home care services, however, this is subject to certain conditions, by the chosen Medicare variant depend (Medicare). Some private insurance companies reimburse some home care services (eg. As administration of infusions) and for patients who are not bound domesticated. For patient care that is to be recovered from third parties, doctors must certify that home care is required, and for Medicare that patients comply with the requirements of Medicare for home care. Medicare requires that agencies report on home care patients what services are recoverable. Domestic care services that are provided on a detailed assessment out (Outcome and Assessment Information Set [OASIS]); this is performed by a nurse or a therapist, when the patient is admitted to Medicare. Third-party payers limit the personal services increasingly to control costs. Agencies for home care receive reimbursement directly from Medicare, Medicaid or private insurers.