Programs Help Seniors Age at Home

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Jennifer VanWinkle By Jennifer VanWinkle 
Clinical Product Manager, Change Healthcare
Programs Help Seniors Age at Home

Helping people gracefully age in place is the ideal in healthcare. But getting paid for preventive care to keep people in their homes has been rare in a fee-for-service environment. Fortunately for seniors and hopefully for home care organizations, the Centers for Medicare & Medicaid (CMS) continues to look at innovative ways to keep patients and potential patients in the lowest-possible cost settings. More often, non-medical assistance can help keep seniors stay longer in their homes— often the setting with the lowest possible cost.

Health Affairs reported in September on the results of a program started in 2012 to help seniors better perform activities of daily living (ADLs). The program involved both medical interventions like occupational therapist and nurse visits and non-medical interventions such as home repairs or modifications that made it easier for seniors to navigate their homes.

The demonstration project, part of the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program, involved 234 low-income, elderly participants in Baltimore. Participants received five months of assistance, both medical and non-medical. The findings from Johns Hopkins University showed:

  • 75% of participants improved their performance of ADLs
  • 65% improved their performance on such tasks as shopping and medication management
  • 53% reduced symptoms of depression

Cost for each participant averaged $2,825, which is significantly less than a single hospital stay and can keep people in their homes longer. Those funds covered any necessary home repairs, home visits from nurses and therapists, and assistive devices that could help keep participants at home, according to an article on the program.

Needs Beyond Healthcare

The program, funded by the Center for Medicare and Medicaid Innovation (CMMI), included 10 visits across five months. Those visits were from a combination of nurses, therapists and handymen who helped install assistive devices based on the priorities of each participant.

For someone who wanted to continue to cook his own meals, for example, shelves may have been lowered to accommodate finding needed items without getting on a stepstool. Multistory houses likely required additional handrails to facilitate going up and down stairs. Bathroom modifications made it possible for more seniors to bathe or go to the toilet by themselves.

Home health can play a critical role in proactive interventions like these. We are accustomed to evaluating a patient’s home situation, understanding a patient’s ADL capabilities and wishes and helping people set achievable goals. Home health is the ideal situation to help health systems and other providers operate programs such as these.

The authors haven’t yet determined whether these interventions will result in cost savings for CMS, but it’s logical to think that modest outlays that keep people out of hospitals, nursing homes and rehab facilities after suffering fractures at home will more than pay for themselves. A larger, separate study, also in Baltimore, will explore the idea of proactive interventions further. Michigan is piloting a similar study with disabled Medicaid recipients who are eligible for nursing home care but want to stay at home.

As health systems (and home care organizations) continue to take on more risk for patient populations, proactive outreach will become a vital tool to keep people in the lowest-possible cost setting—home.

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