Use of Home-Based Clinical Care and Long-Term Services and Supports Among Homebound Older Adults |
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| Affiliation: | 1. Icahn School of Medicine at Mount Sinai, New York, NY, USA;2. LeadingAge LTSS Center@UMass Boston, Washington, DC, USA;3. Massachusetts General Hospital, Boston, MA, USA;4. Johns Hopkins University School of Medicine, Baltimore, MD, USA;5. Johns Hopkins University School of Nursing, Baltimore, MD, USA;1. Geriatrics and Extended Care Data and Analysis Center (GECDAC), Finger Lakes Healthcare System, Canandaigua, NY;2. Center for Gerontology and Healthcare Research and the Department of Health Services, Policy, and Practice, School of Public Health, Brown University;3. Public Health Sciences, University of Rochester, Rochester, NY;4. Department of Medicine, University of Rochester, Rochester, NY;5. VA Connecticut Healthcare System, West Haven, CT;6. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA;1. Health Economic Unit, University Hospital of Toulouse, Toulouse, France;2. Department of Medical Information, University Hospital of Toulouse, Toulouse, France;3. LIRAES (URP 4470), Chaire AgingUP!, LIEPP Sciences Po, Paris, France;4. Department of Geriatrics, Hospital and University of Toulouse, Toulouse, France;5. Department of Geriatrics, University Hospital of Montpellier, Montpellier, France;6. Clinical Geriatric, University Hospital of Limoges, Limoges, France;7. French National Public Health Agency, Saint-Maurice, France;8. Directorate of Non-Communicable Diseases and Injuries, French National Public Health Agency, Saint-Maurice, France;9. French Court of Auditors, Paris, France;10. Locomotor Institute, University Hospital of Toulouse, Toulouse, France |
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| Abstract: | ObjectivesDescribe use of home-based clinical care and home-based long-term services and supports (LTSS) using a nationally representative sample of homebound older Medicare beneficiaries.DesignCross-sectional study.Setting and ParticipantsHomebound, community-dwelling fee-for-service Medicare beneficiaries participating in the 2015 National Health and Aging Trends Study (n = 974).MethodsUse of home-based clinical care [ie, home-based medical care, skilled home health services, other home-based care (eg, podiatry)] was identified using Medicare claims. Use of home-based LTSS (ie, assistive devices, home modification, paid care, ≥40 hours/wk of family caregiving, transportation assistance, senior housing, home-delivered meals) was identified via self or proxy report. Latent class analysis was used to characterize patterns of use of home-based clinical care and LTSS.ResultsApproximately 30% of homebound participants received any home-based clinical care and about 80% received any home-based LTSS. Latent class analysis identified 3 distinct patterns of service use: class 1, High Clinical with LTSS (8.9%); class 2, Home Health Only with LTSS (44.5%); and class 3, Low Care and Services (46.6% homebound). Class 1 received extensive home-based clinical care, but their use of LTSS did not meaningfully differ from class 2. Class 3 received little home-based care of any kind.Conclusions and ImplicationsAlthough home-based clinical care and LTSS utilization was common among the homebound, no single group received high levels of all care types. Many who likely need and could benefit from such services do not receive home-based support. Additional work focused on better understanding potential barriers to accessing these services and integrating home-based clinical care services with LTSS is needed. |
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| Keywords: | Long-term care aging in Place home- and community-based services home-based medical care |
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