Frail Older Adults Not Getting the In-Home Health Care They Need
By Robert Holly | November 15, 2018
A huge gap exists between the need for home-based medical care and what is actually being provided to frail older adults, especially in rural areas, a new study has found. There also appear to be significant disparities in access to home-based care between male and female patients as well.
The study was published in the Journal of the American Geriatrics Society.
“Most homebound seniors have not received medical care at home,” Nengliang “Aaron” Yao, one of the study’s authors and an assistant professor at the University of Virginia School of Medicine, said in a statement. “More medical house call programs are needed.”
To further evaluate the use of home-based medical care in frail patient populations, Yao and researchers from Johns Hopkins University, the University of California, San Francisco, and the Home Centered Care Institute analyzed scores of Medicare claims from 2011 to 2014. To single out frail Medicare beneficiaries, the team of researchers “scored” patients based on the number and severity of their health impairments
About 7% of the Medicare patients included in the researchers’ analysis were considered “frail.”
Throughout the health care community, frailty is generally seen as something linked to exhaustion, weigh loss, low activity, slow gait speed and weak grip strength.
Among the frail older adults identified in the study, less than 10% received medical care at home in 2011. While there was a slight uptick in home-based care use from 2011 to 2014, the vast majority of frail Medicare beneficiaries still did not receive medical care at home.
“Most of us agree that the bedrock of clinical care is human connection,” Yao said. “Visiting the sick at home re-humanizes care for frail patients.”
Health care in rural areas
Access to home health care in America’s rural communities, in particular, has long been an issue. Policymakers have tried to address the challenge through rural add-on payments, which give home health agencies operating in sparsely populated and remote counties a slight financial boost.
During their study, researchers found that only 2% to 4% of rural Medicare recipients received home-based medical care, with rural residents 78% less likely to receive home-based care than Americans living in the most metropolitan of counties.
U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma touted the agency’s commitment to rural health care in a statement released on Thursday — National Rural Health Day.
“Approximately 60 million people live in rural areas — including millions of Medicare and Medicaid beneficiaries,” Verma said. “We at CMS recognize the many obstacles that rural Americans face, including living in communities with disproportionally higher poverty rates, more chronic conditions, and more uninsured or underinsured people.”
Michigan, Florida and Arizona had the highest percentages of Medicare beneficiaries who received home-based medical care between 2011 and 2014, according to the study. Vermont, Idaho, Wyoming, Iowa, Louisiana, Arkansas, South Dakota, Mississippi and North Dakota had the lowest percentages.
In 2014, many deaths among rural Americans were preventable, including those from heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke, according to the U.S. Centers for Disease Control and Prevention.