Throughout the 1990s, psychiatric home care seemed to be on the verge of exploding. The number of in-patient psychiatric beds decreased; hospital stays became shorter; and patients were being maintained in the community with a much higher symptom burden than before. At the same time, traditional community psychiatric services, rapidly becoming overwhelmed, were looking to alternative providers to bolster their services.
However, current Medicare home health coverage guidelines have precluded treatment of patients with mental illness by home health agencies (HHAs). Conditions such as restrictive psychiatric clinician qualification requirements, restrictive homebound criteria relative to patients with mental illness, lack of an easily identifiable end point to the disease process of mental illness, and difficulty identifying a skill reimbursable by Medicare make treating this patient population difficult. More specifically, home care practitioners in general fail to recognize the effect of psychiatric conditions on how patients experience medical illness and how these comorbid psychiatric conditions affect patient functioning, engagement in treatment, treatment compliance, and recovery.