Home and Community-Based Services vs. Nursing Facilities

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Table of Contents

Introduction
Michigan’s Elderly Population and Existing Long-Term Care System
Comparing Home Care with Nursing Care and 1915(c) Wavers
Home Care and Community-Based Interventions
Conclusions
Works Cited

Introduction

Healthcare is one of the most expensive industries in the US. Healthcare expenditures have exceeded 3.3 trillion dollars for the past year. With the country’s growing population and the last of the Baby Boomers entering retirement, there are chances that healthcare expenses are going to grow. Expensive healthcare is associated with poor quality and increased morbidity and mortality rates among vulnerable populations. Preventive care has proven to be an effective tool in reducing the number of readmissions for the elderly populations and improving the quality of healthcare outcomes. In so doing, it also helped reduce the costs associated with hospitalization and ambulatory treatments. Massachusetts has been providing home and community-based treatments to a limited number of patients, with increased cost-efficiency in comparison to nursing facilities. The purpose of this brief is to highlight the evidence in favor of expanding access to home and community-based treatments for the disabled and elderly patients as opposed to 1915(c) waivers and nursing treatments.

Michigan’s Elderly Population and Existing Long-Term Care System

According to Granholm and Olszewski (6), Michigan is facing a serious crisis in its long-term system. The projections for the year 2016 were that over 1,544,000 elderly American citizens would require the services of the long-term care system (Granholm and Olszewski 4). Some of the greatest challenges of the system that were identified in the report were housing problems and the long-term care workforce. Retirement houses can support only a limited percentage of the population, which means that the majority of the population will not be eligible for occupancy. At the same time, hospitals and nursing homes throughout the USA are suffering from extremely high turnover rates, ranging from 15% to 25%. These turnovers are not only increasing the prices for healthcare but also result in decreased quality of care for the patients.

Comparing Home Care with Nursing Care and 1915(c) Wavers

Elderly and disabled patients are most vulnerable to poor quality of care, which is associated with increased chances of hospitalization and even death. Nursing expenditures are currently on the rise and stand at 1.78 billion dollars. Medicaid expenditures for nursing facilities in Michigan for 2015 are at 179.78 USD per person per year (Eiken et al. 121). At the same time, 1915(c) waivers, which enable individuals to receive community-based help, are at 30.68 dollars per person. Home health measures, on the other hand, are directly affecting the expenses for nursing care. According to Eiken et al. (121), current expenditures for Home healthcare are at 0.71 dollars per person, which is significantly less when compared to waivers and other measures. As it stands, however, too few individuals have access to home care due to various restrictions that prevent people from using it. Expanding home care to include more individuals by adding home care to the 1915(c) waiver is considered a prudent step, as it would potentially save money through preventive measures and by taking some patients off the nursing services account.

Home Care and Community-Based Interventions

Home care and community-based interventions have several advantages over post-factum medical treatment. They are aimed at improving self-sufficiency in elderly, mental, and disabled patients while introducing a number of preventive measures in order to avoid hospitalization and nursing home treatment (Fox-Grage and Walls, 12). These interventions are much cheaper when compared to full treatments. In addition, home treatments do not require specialized hospital spaces in order to administer care. In many cases, the families are fully capable of looking after the patient.

Due to these factors, home care and community-based interventions are viewed as suitable solutions to the growing geriatric care problem. According to the resource allocation document, home health allocations for 2015 in Michigan were at 7,120,364 dollars (roughly 0.72 cents per patient per year) (Eiken et al. 121). At the same time, the expenses associated with home care saw a 5% decrease. The report by Granholm and Olszewski state that increases in-home care expenditures in Michigan in 2009 was followed by decreases in nursing home care expenditures, at a much greater proportion.

The correlation is simple to follow – preventive care helps decrease the number of instances when patients need to visit the hospital seeking ambulatory treatments. As a result, hospitalization rates decrease, thus reducing the amount of money spent on it as part of the Medicare and Medicaid programs. At the same time, home care and preventive treatments are associated with fewer instances of re-hospitalization.

Looman et al. (1) state that preventive care, along with integrated care, produces better patient outcomes for frail elderly patients when compared to the usual healthcare they receive at the hospitals. Elderly patients are particularly vulnerable to incidents associated with falling caused by side effects of medications, treatments, or simple accidents. Preventive care aimed at improving motion stability effectively reduces fall-related trauma. Care-Kulis et al. (69) state that various training programs available to the patients, which utilize exercises, healthy diets, and increases in vitamin D produce a net return of interest ranging from 64% for the Stepping On program to 509% for Tai Chi: Moving for better balance programs. Even at their worst, the return of interest is capable of covering not only the implementation costs but also the expected medical treatment costs as well.

Another intervention as a part of the home care and prevention program is the phone instruction service. Hospitals are capable of maintaining web-based and telephone-based monitoring of patients that have long-term health problems or have been recently discharged from hospitals. This intervention is stated to improve post-hospital care by identifying key issues early on and enabling patients to conduct self-treatment and prevention activities more efficiently. According to Tang et al. (1516), the majority of issues resolved through phone calls were medication refill needs, medication clarification, and home care needs. These three positions amounted to about 70% of the issues most prevalent in-home care patients.

The last intervention performed in the scope of home care in Michigan is nurse home visits to patients. They are performed with the purpose of performing medical check-ups, providing instructions, answering questions, and addressing other home care needs. These interventions are inherently cheaper when compared to hospital appointments because they do not need hospital space or specialized equipment. According to Buss et al. (220), nurse visits are having a positive impact on the care dependency and functional status of patients while decreasing re-hospitalization rates among recently discharged patients.

Conclusions

Michigan’s geriatric population is continuing to grow, as the last of the Baby Boomer generation is retiring. This issue is associated with increases in expenditures for nursing and ambulatory care. In addition to being taxed on the state budget, it presents a potentially unsolvable issue for the local healthcare institutions, which are experiencing a lack of space and medical personnel. Increasing expenditures for home care and home-based interventions is a potentially effective way of dealing with the problem. In order for Michigan to cut medical care-related expenses, it should invest in Home Health as a potential venue in addition to the 1915(c) waiver program and nursing care. Home Health is cheaper when compared to these other programs, it is efficient, as proven in numerous studies, and it is less costly. Doing so would help prevent nursing home admissions and save the state large amounts of money.

Works Cited

Buss, Arne et al. “Effectiveness of Educational Nursing Home Visits on Quality of Life, Functional Status and Care Dependency in Older Adults with Mobility Impairments: A Randomized Controlled Trial.” Journal of Evaluation in Clinical Practice, vol. 22, no. 2, 2016, pp. 213-221.

Carande-Kulis, Vilma et al. “A Cost-Benefit Analysis of Three Older Adult Fall Prevention Interventions.” Journal of Safety Research, vol. 52, 2015, pp. 65-70.

Eiken, Steve et al. Medicaid Expenditures for Long-Term Services and Supports (LTSS) in FY 2015. 2017. Web.

Fox-Grage, Wendy, and Jenna Walls. State Studies Find Home and Community-Based Services to Be Cost-Effective.2013. Web.

Granholm, Jennifer M., and Janet Olszewski. Michigan Profile of Publically-Funded Long-Term Care Services.2009. Web.

Looman, Wilhelmina M. et al. “The (Cost-)Effectiveness of Preventive, Integrated Care for Community-Dwelling Frail Old People: A Systematic Review.” Health and Social Care, vol. 2018, 2018, pp. 1-30.

Tang, Ning et al. “Evaluation of a Primary Care-Based Post-Discharge Phone Call Program: Keeping the Primary Care Practice at the Center of Post-Hospitalization Care Transition.” Journal of General Internal Medicine, vol. 29, no. 11, 2014, pp. 1513-1518.

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