Home Health Care for Acutely Ill Elderly Populations Quicker, Cheaper, Better? Lyn O’Brien, MS, RN, ANP Geriatric Home Care Nurse Practitioner, Deaconess- Waltham Hospital, Waltham, MA Carl W. Nelson, PhD Associate Professor, Northeastern University, Boston, MA

Challenges “Having armies of home care workers traveling to geographically disparate locations to visit patients requires more resources than would be needed to care for the same patients, if they were concentrated in half-empty hospitals”. Uwe Reinhardt, (New York Times, 4/26/00).

Challenges “…home care has been burdened by unrealistic expectations, inadequate attention to the specific outcomes achievable for various subgroups, and, to some extent, poor management due to a lack of understanding of the nature of its cost structure and lack of adequate attention to cost- saving strategies born of a missionary sense that net savings would be automatic”. Weissert, Health Services Research, 20(4)

Heightened Risks Hospitalized elders experience medical injury two to four times as often as patients in other age groups The incidence of nosocomial infections in older adults ranges from 5.9 to 16.9 per 1000 hospital days patients exposed to high ICU workload were more likely to die than those exposed to lower workload, regardless of health risks profound deterioration in gait during hospitalization …generalized “deconditioning” … rate of fall from approximately 3.8 to 7.0 per patient-days for older adults

Caregiver Burden Between 7 and 23million people are informal caregivers …$45-$190 billion per year if replaced by paid professional staff Caregivers sacrificed an average $566,000 in wages, $67,000 in pension benefits, and $26,000 in Social Security benefits. Additionally, caregivers spent an average $20,000 on food, transportation, housing. Five in six caregivers were forced to quit, retire prematurely, cut back their work hours, or take sick time, vacation time, or a leave of absence from work. Three- quarters of the caregivers suffered a health problem related to being a caregiver.

Too Much Focus on Costs? “Cost-effectiveness is not the only rationale for home care. The best argument for home care is that it is a humane and compassionate way to deliver health care and supportive services. Home care reinforces and supplements the care provided by family members and friends and maintains the recipient’s dignity and independence, qualities that are all too often lost even in the best institutions. Further, home care allows patients to take an active role in their care, becoming members of a multidisciplinary health care team.” ( NAHC, 2000)