By Geralyn Magan
Many homebound older adults do not receive home-based clinical care or home-based long-term services and supports (LTSS), according to a new study.
Homebound older adults could benefit from using a combination of in-home clinical care and in-home long-term services and supports (LTSS). But a recent study found that “many who likely need and could benefit from such services do not receive home-based support.”
The study, published in the Journal of the American Medical Directors Association (JAMDA), was co-authored by Robyn Stone, co-director of the LeadingAge LTSS Center @UMass Boston. It can be read free of charge through June 15, 2023.
Researchers analyzed data from the 2015 cohort of the National Health and Aging Trends Study (NHATS). NHATS examines late-life disability and function among Medicare beneficiaries 65 and older. The study sample included 974 homebound older adults who had at least 12 months of fee-for-service Medicare claims data prior to their interviews for the NHATS study.
DOCUMENTING LOW USE OF IN-HOME SERVICES
Researchers found that approximately 30% of the study sample received home-based clinical care, defined as care provided at home by physicians, physician assistants, or nurse practitioners; skilled home health care; or home-based clinical care from other providers, such as podiatrists.
About 80% of the study sample received home-based LTSS in a variety of categories, including assistive devices, paid helper assistance with a functional task, transportation assistance, senior housing, home-delivered meals, or 40 or more hours of caregiving support from nonpaid helpers each week.
Three distinct patterns of service use among homebound older adults were identified during the study:
High Clinical with LTSS (8.9%). The smallest group of study participants received extensive home-based clinical care. This group was older, more likely to have dementia, and more likely to live alone.
Home Health Only with LTSS (44.5%). This group received some home health services but few other forms of home-based clinical care. Their use of LTSS was similar to the group receiving high clinical care with LTSS.
Low Care and Services (46.6%). The largest group of participants received little home-based care of any kind. This group was younger, had fewer chronic conditions, and had fewer functional impairments than the other groups.
Researchers concluded that although home-based clinical care and LTSS utilization were common among the homebound, no single group received high levels of all care types.
“Given that this is a homebound population, such findings likely reflect not a lack of need but rather a lack of acceptability, availability, and/or affordability of home-based LTSS,” write the authors.
The authors recommend that future research focus on “robustly characterizing and assessing the adequacy of home-based LTSS within the context of other forms of home-based care.” Such research will help support efforts to “improve access to the care, services, and supports that keep the homebound safe at home,” they conclude.