Performance Improvement 2010. Prevent Institutional Care; Provide Home Care


ASPE research comparing two programs intended to prevent or postpone nursing home placement found that expanded availability of federal Medicaid matching funds did not change caregiver or patient behavior.  However, participants in the programs with relatives providing care averaged less than program participants with non-relative providers and the programs were found highly effective at preventing or postponing nursing home placement.  (9304)

An ASPE project examined reporting on Medicare home health agency quality, focusing on how well quality measures reflect the services provided to different types of clients.  Reporting may be unfair to agencies which admit a larger proportion of patients with more serious conditions.  Agencies with a large share of clinically complex community admissions could be disadvantaged compared to agencies serving a large share of post-acute restorative care patients.  The authors found considerable variation in the types of patients served by agencies that differ in size, ownership (hospital-based vs. freestanding), control (for profit, not for profit, government), and geographic location. (9306)

Another ASPE study of assistive home features for near-elderly and older adults found that two-thirds of the population ages 52 and older had one or more assistive home features.  One-third added at least one of these features, and 40 percent had used at least one feature in the previous 30 days.  The most common assistive home features included railings at the home entrance, grab bars in shower/tub, and a seat for the shower/tub.  Among those who added features, roughly one-third spent less than $100, another third less than $500.  Ten percent spent over $1000.  For fewer than 10 percent of those adding features, insurance or government programs paid for some of the cost.  Individuals more likely to have assistive features in their home included those who were older, had another adult in the household, owned their home, or were covered by either Medicare disability insurance or long-term care insurance.  Few health-related factors predicted the existence or addition of assistive home features.  However, if they had assistive features, respondents with high blood pressure, diabetes, cancer, and lower body limitations were more likely to use them.  One in four near-elderly and older adults has a mobility limitation and an unmodified barrier at the entry to their home, inside their home, or in the bathroom.  (9315

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