When consumers, physicians, and members of Congress think about home care, some believe it is strictly high tech, others think of nursing and therapy services, and still others envision personal care such as dressing and toileting. Some key members have claimed home care is nothing but unskilled care.

The integration of technology into the home care setting can be expensive, but it will save money (with good outcomes) for consumers and payors by keeping people out of institutions. Home care is cost-effective, clinically effective, and consumer preferred.

Driven by demographics, home care is destined to be the future of the health care delivery system. Life expectancy is increasing, Baby Boomers have fewer children than their parents, and families are widely dispersed. The nation's health care system will have no choice but to rely more on home care as Baby Boomers enter retirement.

We know that home care is cost-effective and clinically effective, and yet the Administration's Fiscal Year 2008 budget proposal includes Medicare cuts of $65.6 billion, of which $12.6 billion, or 19.2%, is aimed at home care. HME and home health together constitute only 5.6% of Medicare. This illustrates the home care disconnect: The Administration is seeking to rebalance the Medicaid program between institutional services and home care, which is "radically more efficient," according to HHS Secretary Mike Leavitt. At the same time, home care is not valued in the Medicare program by the same Administration that touts it in Medicaid.

The primary missing links in the health care delivery system are personal care for those needing ADL and IADL assistance, and long-term care (LTC) for the chronically ill. Policymakers are busy shifting the financial burden for chronic and long-term care to consumers, telling them it is their responsibility to prepare for the cost of LTC through a mix of personal savings, health savings accounts, LTC insurance, and tax credits and deductions for LTC expenses.

Ultimately, it will be cheaper for consumers to fund home care than to pay for nursing home, assisted living, or other institutional settings for LTC. Other trends contributing to the inevitability of home care include greater patient choice and consumer-directed care. When given the option and appropriate resources are made available, consumers choose to stay in the comfort of their own homes.

We instinctively know that home care is cost-effective, but studies collected by AAHomecare are more anecdotal than scientific. Our telehealth success stories are dramatic, but they tend to be small and self-reported. We need objective data on a large scale. Nevertheless, we know that the cost of home intravenous therapy is a fraction of the cost of the same service in a hospital or skilled nursing facility. A Medicare COPD patient can receive care in the home for a full year at less than the cost of a day in the hospital. Power mobility devices are much more expensive than conventional wheelchairs, but consumers who receive such devices increase their independence and produce cost savings for Medicare over a 3-year period.

As we go forward into the new era of "pay as you go" on Capitol Hill and possible global budgets for Medicare, we need to continue to develop and drive home our message: Home care is not the problem, it's the solution. And technology is the key to bringing health care home from higher-cost institutional settings.

Ann Howard is director of federal policy for AAHomecare, Alexandria, Va. She can be reached via e-mail: .