Use of Home-Based Clinical Care and Long-Term Services and Supports Among Homebound Older Adults.
Jennifer M Reckrey, Duzhi Zhao, Robyn I Stone and 3 others
PMID 37084771WHAT IT FOUND
Most homebound older adults use long-term supports like assistive devices, but very few receive comprehensive care.
Nearly half had minimal services despite being homebound. Clinical teams should screen for gaps in meals, transport, and paid help, not assume skilled home health covers all needs.
Key findings
0180% of homebound older adults used some form of long-term services and supports, with assistive devices being the most common (nearly 50%) and home-delivered meals the least common (<5%).
02Nearly half of the sample (46.6%) belonged to a 'Low Care and Services' class, receiving few home-based clinical or long-term supports despite being homebound.
03Those who received home-based clinical care were more likely to receive long-term services, but usage of the four most common supports was similar regardless of the type of clinical care received.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPsWhat it means for RNs
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What it does not show
The study only included fee-for-service Medicare beneficiaries, so results may not apply to those with Medicare Advantage or no insurance. Long-term service measures were limited to what was asked in the NHATS survey, missing other supports like case management. Small cell sizes prevented detailed reporting of specific percentages for some groups due to CMS anonymity guidelines. The study describes receipt of services, not whether those services met the patient's actual needs. Regional variations in service availability could not be fully evaluated due to sample size.
Declared interests
One author reports serving as an advisor to several home-based care groups and receiving research funding from several foundations. The other authors have no conflicts of interest to declare.
The easy way to misread this
Do not interpret the high percentage of long-term service use as evidence that patients' needs are being met. The study shows that nearly half of homebound patients receive very few services, and no group received a comprehensive mix of all clinical and long-term supports. High use of assistive devices may reflect simple availability rather than adequate care coordination.