Measuring Geriatric Home Care Utilization, Effects, and Costs.

Abstract

While public discussion has accelerated over substituting home care for institutional care of disabled older adults, research and demonstration efforts to document costs and effects provide little guidance for geriatric services policy development. Major obstacles have been lack of identifiable client case-mix, utilization patterns, and subsequent service needs by which comparisons could be made of various long term care programs. Using over 2000 longitudinal case records of a large home care agency, this study used multivariate analysis to identify those entry characteristics which best predicted service use. Duration and intensity were found to vary inversely: short-term clients averaged more visits per month than long-term clients. Pay plan at entry was the strongest predictor of both duration and intensity. Medicare clients (averaging high intensity and short duration) appear to be substituting home care for nursing home use; state-supported clients (averaging low intensity and long duration) appear to use home care to prevent or postpone institutionalization. Contingency tables show that pay plan groups also vary in proportion entering from prior hospital care, proportion living alone, age, and proportions leaving home care by death, to institutional care, to other community services, or to informal arrangements. Disaggregating case mix by pay plan is suggested as useful for planning program resources under current funding systems. Utilization patterns, including exit status, are discussed as more useful than measures of client function for comparing proposals for change in subsidization policy. Definitions and methodology developed here are expected to be useful in research applied to service alternatives for older adults.