NGNA Section Feature ArticleThe Relationship between Severity of Physical Impairment and Costs of Care in an Elderly Population
Section snippets
THEORETICAL RATIONALE
In the model of costs of alternative care settings for the elderly, Pollak13 assumes that total social costs should be the initial basis for cost comparisons. The total social costs of providing care for elderly people in every setting are influenced primarily by their functional impairment and the quality of care provided. Pollak maintains that the cost of care in most community settings also is influenced by the availability of family members to care for an older person. The cost of care
HYPOTHESES
The cost of care for elderly patients with less physical impairment is lower in home care than in the nursing home care setting. The cost of care for elderly patients with more physical impairment is higher in home care than in the nursing home care setting.
Sample and Sampling Plan
The sample for this study included 134 people—67 patients receiving LTC at home from LTHHCPs and 67 residents receiving LTC in nursing homes. Both the home care and the nursing home sample consisted of nursing home-eligible elderly, patients whose admission dates were between January 1 and June 30, 1994, patients whose primary source of payment was Medicaid, and patients whose cognitive status was intact or mildly impaired. Only participants whose score was 1 or less, which indicates
Description of the Sample
The mean age of home care participants was 79 (SD = 8.6), which was 5 years younger than the mean age of those in the nursing home (T = -.366, P <.001). No significant differences occurred in gender, ethnic background, and marital status between the home care sample and the nursing home sample. However, significant differences arose in types of primary diagnoses at the time of admission and referring sources of admission between the samples. In the home care sample, approximately half the
CONCLUSION
As shown in these findings, the actual cost of home care exceeded that of institutional care for heavily dependent elderly patients who need a lot of family care. The results of this study raise a question about the cost-effective use of home care in the LTC delivery system. The cost-effective use of various LTC options depends on targeting services to people who could be cared for most efficiently in different settings. Although this study assessed the number of in-patient hospitalization and
Acknowledgements
The author wishes to thank Christine T. Kovner, PhD, RN, and Mathy Mezey, EdD, RN, for their support in reviewing several drafts of this article.
References (21)
The older dyadic family unit and chronic illness
Home Healthcare Nurse
(1990)A profile of older Americans
(1995)Aging into the 21st century. National Aging Information Center
Long-term home care research
Nursing and Health Care
(1989)An historical perspective on home care policy
Milbank Q
(1993)Expanding the home care concept: blurring distinctions among home care, institutional, and other long-term care services
Milbank Q
(1995)- et al.
Posthospital home health care for Medicare patients
Health Care Financing Review
(1994) - et al.
Cost of community care for disabled elderly persons: the policy implications
Inquiry
(1990) - et al.
The economic burden of Alzheimer’s disease care
Health Affairs
(1993) - et al.
The increased needs of patients in nursing homes and patients receiving home health care
N Engl J Med
(1990)
Cited by (5)
A prediction model for low functional status after colorectal cancer surgery: A retrospective cohort study using administrative data
2023, International Journal of Surgery OpenThe Behavioral Assessment Scale: A Measure of Community Living Skills
2007, Journal of the Association of Nurses in AIDS CareEstimating Long-Term Care Costs among Thai Elderly: A Phichit Province Case Study
2018, Journal of Aging ResearchNursing shortage: The facts and strategies in Macao society
2013, Online Journal of Issues in NursingClinical outcomes of aging in place
2005, Nursing Research