We summarize recent Medicare and other evidence on the efficacy and costs of treating acutely ill elderly patients in their homes as opposed to inpatient hospital settings. We specifically find fault with the assertions of Uwe E. Reinhardt, a professor of economics at Princeton University, and others, who argue in sum: “Having armies of home care workers traveling to geographically disparate locations to visit patients requires more resources than would be needed to care for the same patients, if they were concentrated in half-empty hospitals”. Such reasoning fails to identify the unforeseen costs attributable to hospitalization (mainly risks associated with medical errors, hospital-acquired infections, decline in functional status and patient falls), and the costs (caregiver, compliance) and benefits of home health care (education, prevention, early diagnosis, family care-giver involvement, and telemedicine).
We show how more realistic cost comparisons can be derived from the following factors:
1.Per diem comparisons of hospital versus home care are misleading. 2.Elders experience hospital medical injury two to four times as often as patients in other age groups. 3.Half of all hospital nosocomial cases occur in elders. 4.Generalized “deconditioning” associated with hospitalization prolongs length of stay and increases the probability of outpatient and home treatment. 5.Falls are up to almost three times as likely for the hospitalized elderly as compared to those in the community. 6.Out-of-pocket costs and opportunity costs associated with caregivers are significant. 7.Unique benefits accrue to elders who receive home care.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to appreciate the limitations of narrowly drawn policy conclusions on the costs of home care for acutely ill elderly patients. We specifically show: 1.Per diem comparisons of hospital versus home care are misleading. 2.Elders experience hospital medical injury two to four times as often as patients in other age groups. 3.Half of all hospital nosocomial cases occur in elders. 4.Generalized “deconditioning” associated with hospitalization prolongs length of stay and increases the probability of outpatient and home treatment. 5.Falls are up to almost three times as likely for the hospitalized elderly as compared to those in the community. 6.Out-of-pocket costs and opportunity costs associated with caregivers are significant. 7.Unique benefits accrue to elders who receive home care.
Keywords: Home Care, Elderly
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.