d intravenous fluids there are countless possibilities for treatment within the home setting. As stated in The Continuum of Long Term Care "Home health programs range from formal organizations providing skilled nursing care to relatively informal networks that arrange housekeeping for friends" (p. 185). This has allowed for home care to quickly become an essential component of the health c! are delivery system in the United States.
             In a home health care situation the primary care giver is usually not the physician. The physician is communicated with by phone and with documentation from the caregivers. The primary caregivers are usually the nurses and other team members who are involved directly with the patient's care. Although, the original order to begin home care must be initiated by the physician if skilled care is to be obtained. According to the 1995 Guide to Health Insurance for People with Medicare "Medicare pays the full cost of medically necessary home health visits by a Medicare-approved home health agency" (p. 5). This coverage must meet specific criteria, but it can be a relief to family members to know that their loved ones can be taken care of at home without worrying about the expenses.
             Unfortunately, if the care to be given within the home is termed "not medically necessary" the expense is not covered. This can include items such as meal and medication delivery, a percentage of necessary durable medical equipment, personal care and homemaker services. My employment within a home health care agency has allowed for review of services that are not covered by Medicare and/or private insurance. Health care services that
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