Introduction: Past studies seldom have focused on dually-eligible (Medicare and Medicaid beneficiaries) populations and none has examined this population in a home care setting. The purpose of this study was to compare the characteristics and needs of home care recipients who are dually-eligible as compared to Medicare-only beneficiaries. Methods: Using Outcome Assessment Information Set (OASIS) records, all unique first admissions to home care during 1999 (n=50,829) were examined to identify care recipients who were > 65 years of age and either dually-eligible (n=6,306) or Medicare-only beneficiaries (n=14,879). OASIS data were linked to community indicators using Census Bureau data. Odds ratios, 95% confidence intervals, and P values were computed. Results: As compared to Medicare-only home care recipients, the dually-eligible were significantly more likely to be women, live in poorer communities, be ethnic/racial minorities, have more co-morbidities, be dependent on polypharmacy, experience pain more frequently, have poorer psychological health, be referred from and discharged to an in-patient setting. Few differences were observed in diagnoses and ADL and IADL dependencies at admission. Although the median length of stay was similar between the two groups, the dually-eligible received significantly more skilled nursing and home health aide services. In addition, the dually-eligible appeared to rely more heavily on formal rather than informal caregivers. Conclusions: The dually-eligible are in relatively poor health, use a high volume of home health services, and have fewer informal care resources. With the implementation of the prospective payment system, these combined undesirable characteristics may impact targeting and provision of services.
Learning Objectives: At the conclusion of this session, the participant will be able to: 1. Describe demographic characteristics of the dually-eligible as compared to Medicare-only beneficiaries in home care; 2. Identify health similarities and differences between the dually-eligible and Medicare-only beneficiaries at admission to home care; and 3. Discuss the home health service utilization patterns of the dually-eligible as compared to Medicare-only beneficiaries.
Keywords: Home Care, Medicare/Medicaid
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Visiting Nurse Service of New York
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.