A huge proportion of Medicare beneficiaries who are homebound do not receive medical or other services, suggesting that U.S. home care providers have a large untapped market.
“The homebound population of older adults is 50% larger than the nursing home population in this country but almost completely invisible,” said Sarah Szanton of the Johns Hopkins School of Nursing, in a statement announcing new research findings. “Only 11% receive homebound medical care, and the others may receive no care or intermittent care.”
Out of all community-dwelling Medicare beneficiaries, about 5.6% were homebound as of 2011, according to findings published this week in JAMA Internal Medicine by Szanton and her colleagues. That translates to more than 395,000 totally homebound seniors and more than 1.5 million who were partially homebound, meaning they could leave the home only with assistance or had difficulty leaving the home.
These homebound individuals were more likely to be older, female and non-white, with less education and income than the average Medicare beneficiary.
Certain policy changes and programs under the Affordable Care Act, such as the Independence at Home demonstration, have increased services to homebound individuals. However, their findings can inform improvements in clinical and social services for this population, the authors noted.
“As Medicare considers home health payment reform and changes in the methods of paying for medical care, the development and dissemination of home-based primary care and associated quality frameworks are essential,” they wrote. “Much of what we know about homebound individuals is based on studies of those who receive home health care services or home-based primary care. Combining survey data with administrative data on service use may inform the development of improved clinical services for homebound individuals.”
The findings are based on an analysis of cross-sectional data from the National Health and Aging Trends Study collected in 2011. In addition to Johns Hopkins School of Nursing, authors were affiliated with a variety of institutions, including Icahn School of Medicine at Mount Sinai in New York City and the Geriatrics Division at the Department of Medicine at the University of California, San Francisco.
Written by Tim Mullaney