Quality Measures Needed for In-Home Care

A large proportion of elderly adults are homebound, or have limitations that make it difficult to leave their homes to go grocery shopping or even receive needed medical care.

Elderly adults often have difficulties in receiving proper medical care, and some forgo the care altogether. These patients often have poor disease control, and rely heavily on caregivers for assistance, according to a new report from the Commonwealth Fund.

These patients have even more difficulties when receiving emergency care services at a hospital since the providers are unfamiliar with their conditions. These patients may receive fragmented follow-up care, which could lead to additional hospital admissions.

Better addressing the needs of this population has proven difficult for providers and insurers. Identifying this population and applying appropriate risk management strategies could potentially lower healthcare costs and improve patient outcomes.

Recent studies have suggested that these patients are more likely to be African Americans, insured through Medicaid, unmarried, and have extremely limited mobility. These patients are also more likely to have little education, poor health, symptoms or dementia or depression, and have been hospitalized in the previous 12 months, according to the report.

Homebound patients have expressed the need for assistance with day-to-day living, as well as the need for rest and support for the caregiver. Patients also said that affordable home-based medical care was also something that could reduce hospital visits, and provide them with peace of mind.

To better assist these patients, health systems have begun creating in-home primary or palliative care initiatives, according to the article. These models are largely based on the Independence at Home Demonstration from the US Centers for Medicare and Medicaid Services, which shows that home-based primary care saves money.

However, quality measures are needed to determine the value of these programs, and ensure that patients are receiving the most beneficial treatments. Currently, strict quality measures for this care do not exist.

Quality measures are typically focused on services received at clinics, and other care facilities. These measures may be harmful for homebound patients with limited mobility.

Common primary care quality measures, such as cancer screening, lipid monitoring, and blood glucose control, offer insignificant benefits for patients, according to the study. In these patients, strict blood glucose control can result in low levels and falls, which could result in higher resource utilization and unnecessary costs.

Implementing current quality measures to homebound elderly adults could also result in harm stemming from over-testing and overtreatment of conditions.

Quality measures created specifically for this population should align their treatment goals and needs to ensure that they are receiving proper care, and home health aides are receiving proper compensation, the article concluded.