A new federally funded study challenges the widespread notion that expansion of long-term home-care programs for the disabled and frail elderly would save the government billions of dollars in the long run by averting the use of costly nursing homes.
For years, advocates of long-term home care have contended that keeping the elderly at home, even if expensive, in the end is far less costly than sending them to nursing homes.
Nursing homes average $22,000 per person a year. Having someone come into a person's home a few hours a day or a few days a week to cook, clean, shop, administer medicine, help the person change clothes and bathe is much cheaper and can save many thousands of dollars per person, supporters of home care said.
Last week, this argument was made as one justification for a proposed $5 billion-a-year federal long-term home-care bill for elderly and disabled adults and disabled children sponsored by Reps. Claude Pepper (D-Fla.) and Edward R. Roybal (D-Calif.).
The bill, which the Pepper-led Rules Committee authorized to be sent to the House floor next year, would provide home-care benefits to people who need help for two or more normal activities of daily living, such as eating, bathing, dressing or moving around.
"Many of these individuals would require costly nursing home and hospital care without proper home-care services," according to a "fact sheet" distributed by bill sponsors.
However, a study funded in part by the National Center for Health Services Research and Health Care Technology Assessment found little evidence that expanding publicly funded home- and community-care services cut nursing home admissions enough to offset the extra costs. The center is part of the Department of Health and Human Services.
Expanding such services may still be worthwhile because they improve the recipients' quality of life, the study said, but big savings cannot be expected.
The study looked at 16 experimental projects over the past decade and more in which extra home care was provided for one group of "frail elderly" while another "control group" of similar people in the same community did not receive the extra care.
The study looked at how many people in each group ended up in nursing homes, how long they stayed and what the cost consequences were.
The study found that on the whole, neither the treatment group nor the control group was likely to spend too much time in nursing homes during the year following enrollment in the experiment. The average number of days in nursing homes for those who received the special long-term home care was less but not much less in most cases, so the number of nursing home days avoided was "modest."
In one experiment, both the treatment group and the control group spent 46 days per person on average in nursing homes during the year studied. In another, the treatment group number was 22 days, the control group, 29 days. In only one or two experiments was the treatment group's average nursing home days in the year after enrollment significantly less than that of the control group.
Overall, the study said, "small reductions in nursing home costs for some people are more than offset by the increased costs of providing expanded community services to others who would remain at home even without expanded services."
But the study, carried out under the auspices of the Institute for Research on Poverty at the University of Wisconsin, said the lack of savings is not necessarily a reason to abandon the idea of improving home-care services.
Providing people with more publicly funded home-care seems to improve the quality of life, the authors said, and does not seem to reduce the "care provided informally by family and friends."