Partnerships with providers of social services could be an avenue for reducing preventable health care use in older adults, and in-home care providers can play a role.
With social determinants of health and population health becoming more prominent in health care, cross-sectoral partnerships with Area Agencies on Aging (AAA) could give home care and home health agencies an edge, the findings of a new study in Health Affairs suggest.
AAAs coordinate social services for older adults across the U.S. and regularly work to address social determinants of health. This is sometimes done in partnership with other health care organizations, such as long-term care facilities, behavioral and mental health organizations, hospitals and community health care providers.The agencies historically have provided, funded and coordinated a variety of services to enhance independence for older adults, such as in-home care, case management and transportation, the study noted.
The study examined whether the involvement of AAAs in cross-sector collaborations was associated with decreases in potentially avoidable health care spending and use among older adults in the AAAs’ planning and service areas. They focused particularly on hospital readmissions and nursing home residents.
The researchers looked at data from the National Aging Network Survey of Area Agencies on Aging, which was administered to 613 AAAs in 2013 by the National Association of Area Agencies on Aging in partnership with the Scripps Gerontology Center at Miami University of Ohio. Researchers also used data on a U.S. county level for three measures of avoidable health care use and spending for 2014.
“We were really interested to find that there does seem to be a relationship between some of the AAA programs, as well as some AAA partnerships, and potentially preventable health care use among older adults,” Amanda Brewster of the Yale School of Public Health, one of the study’s authors, told Home Health Care News.
Nursing home overuse
The study measures of avoidable health care use included: all-cause risk-stratified hospital readmission rates (RSRRs), total Medicare spending per beneficiary and the percentage of nursing home residents in a county of low-care status. Stronger care coordination services could prevent these placements by meeting in-home care needs, the study said.
Counties whose AAAs had a program to divert consumers from nursing home placement would have a 20% lower share of residents who were at low-care status, Brewster said. Low-care status indicates residents who are relatively high functioning and did not need extensive physical assistance to identify unnecessary nursing home placement.
“A number of those might be able to manage at home if they had the right kind of social support, such as transportation and in-home services,” Brewster explained.
Though the research did not directly measure the role of home care partnerships with AAAs, home care services could play a key role in addressing many of the preventable readmission measures, Brewster said.
“You could imagine that home health and home care or in-home support—some of which are actually provided by AAAs—that some of those could head off some of the health care complications before they escalate to the point that older adults need to get expensive health care,” she said.
Takeaways for home health
Investigating the impact of specific AAA partners, including in-home care providers, on preventing avoidable uses of health care services is an important focus for future research, Brewster said.
But in the meantime, partnering with AAAs could be a way of addressing the social determinants of health. When it comes to factors such as transportation and nutrition, home care could play a key part.
“As payment models and incentive systems shift to moving more risk to health care providers, I think we’re seeing more interest from health care providers in those social determinants that could improve health in the first place,” Brewster said.
Written by Maggie Flynn