Frail Older Adults Not Getting the In-Home Health Care They Need

A huge gap exists between the need for home-based medical care and what is actually being provided to frail older adults, especially in rural areas, a new study has found. There also appear to be significant disparities in access to home-based care between male and female patients as well.

The study was published in the Journal of the American Geriatrics Society.

“Most homebound seniors have not received medical care at home,” Nengliang “Aaron” Yao, one of the study’s authors and an assistant professor at the University of Virginia School of Medicine, said in a statement. “More medical house call programs are needed.”


To further evaluate the use of home-based medical care in frail patient populations, Yao and researchers from Johns Hopkins University, the University of California, San Francisco, and the Home Centered Care Institute analyzed scores of Medicare claims from 2011 to 2014. To single out frail Medicare beneficiaries, the team of researchers “scored” patients based on the number and severity of their health impairments.

About 7% of the Medicare patients included in the researchers’ analysis were considered “frail.”

Throughout the health care community, frailty is generally seen as something linked to exhaustion, weigh loss, low activity, slow gait speed and weak grip strength.


Among the frail older adults identified in the study, less than 10% received medical care at home in 2011. While there was a slight uptick in home-based care use from 2011 to 2014, the vast majority of frail Medicare beneficiaries still did not receive medical care at home.

“Most of us agree that the bedrock of clinical care is human connection,” Yao said. “Visiting the sick at home re-humanizes care for frail patients.”

Health care in rural areas

Access to home health care in America’s rural communities, in particular, has long been an issue. Policymakers have tried to address the challenge through rural add-on payments, which give home health agencies operating in sparsely populated and remote counties a slight financial boost.

During their study, researchers found that only 2% to 4% of rural Medicare recipients received home-based medical care, with rural residents 78% less likely to receive home-based care than Americans living in the most metropolitan of counties.

U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma touted the agency’s commitment to rural health care in a statement released on Thursday — National Rural Health Day.

“Approximately 60 million people live in rural areas — including millions of Medicare and Medicaid beneficiaries,” Verma said. “We at CMS recognize the many obstacles that rural Americans face, including living in communities with disproportionally higher poverty rates, more chronic conditions, and more uninsured or underinsured people.”

Michigan, Florida and Arizona had the highest percentages of Medicare beneficiaries who received home-based medical care between 2011 and 2014, according to the study. Vermont, Idaho, Wyoming, Iowa, Louisiana, Arkansas, South Dakota, Mississippi and North Dakota had the lowest percentages.

In 2014, many deaths among rural Americans were preventable, including those from heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke, according to the U.S. Centers for Disease Control and Prevention.

How to improving access 

There are several ways the home health industry and federal policymakers can work together to promote access to home-based medical care.

That includes a greater use of telemedicine capabilities, which can help frail individuals connect electronically with doctors, specialists or other care experts without leaving their homes. Likewise, telemedicine is a solution for older adults living in rural areas, where the nearest home health agency, doctors office or hospital may be many miles away.

“Effective use of technology has the potential to reduce the frequency of home visits and make [in-home care] more available in rural communities,” researchers noted in the study.

Federal policymakers recently introduced a proposed rule that would expand access to telehealth services through Medicare Advantage (MA) plans. In addition to providing better care for patients, the proposed rule would also likely be business boon to home health providers and technology vendors, industry insiders previously told Home Health Care News.

“We believe these efforts to promote increased use of technology can help reduce rural health disparities and improve rural patient satisfaction,” Verma said. “We’re committed to maximizing opportunities for making telehealth available for rural patients.”

Improved payment models could also potentially help by encouraging more in-home care providers to enter the space, according to the researchers.

Other key findings

Researchers highlighted a few other interesting findings in their Journal of the American Geriatrics Society study.

For example, men were 24% less likely to receive home-based care services during the window’s timeframe than women, researchers found. Asian patients were 31% less likely to receive home-based care than white patients, while black patients were 21% more likely to receive home-based care than white Medicare beneficiaries.

Besides Yao, the research team included Dr. Christine Ritchie of the University of California, San Francisco, Dr. Thomas Cornwell of the Home Centered Care Institute and Dr. Bruce Leff of Johns Hopkins University.

Leff, who has worked extensively in hospital-at-home programs, is a well-known expert in the home-based care field.

“Home-based medical care will get mainstreamed into the U.S. health care delivery system,” Leff recently told HHCN. “I don’t know how long that’s going to take, but I’m pretty certain about that.”

Written by Robert Holly

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