Most elderly people prefer to remain in their home rather than live in nursing homes. But which setting leads to better outcomes? And how do the costs compare?
A study published in the Gerontologist compares outcomes and costs of the two long-term care settings in Alabama.
From the study:
This matched, retrospective cohort study focused on Alabama residents aged 65 years or older who were admitted to either a nursing home or a home health care between March 31, 2007 and December 31, 2008. Although the ideal study is to compare costs and outcomes among nursing home residents and individuals receiving HCBS, information such as comprehensive assessments and cost of care received under Medicaid waiver programs does not currently exist. However, a related question can be addressed with existing data by comparing nursing home residents to home health recipients who have comparable data available.
And the findings:
After one year, 77.7% of home health beneficiaries were alive compared with 76.2% of nursing home beneficiaries (p < .001). Home health beneficiaries averaged 0.2 hospital visits and 0.1 emergency department visits more than nursing home beneficiaries, differences that were statistically significant. Overall acute care costs were not statistically different; home health beneficiaries’ costs averaged $31,423, nursing home beneficiaries’ $32,239 (p = .5032). Among 426 dualeligible pairs, Medicaid long-term care costs averaged $4,582 greater for nursing home residents (p < .001).
Using data from Medicare claims, beneficiaries with similar functional status, medical diagnosis history, and demographics had similar acute care costs regardless of whether they were admitted to a nursing home or home health care. Additional research controlling for exogenous factors relating to long-term care decisions is needed.
This study sought to compare the acute care costs and outcomes among Medicare eligible nursing home residents with beneficiaries receiving home health, after matching on levels of functional impairment. In such situations, the optimal care setting may be unclear. Many beneficiaries in nursing homes had impairment levels too great to be considered for home health, while many home health recipients were functioning at a level that would not require nursing home care. Using a propensity-score-matched cohort, home health recipients were observed to have more frequent hospital stays and ED visits than the nursing home beneficiaries. However, no differences were observed in the one-year survival rate or the total acute care costs after one year.
