Elsevier

Geriatric Nursing

Volume 21, Issue 2, March–April 2000, Pages 102-106
Geriatric Nursing

NGNA Section Feature Article
The Relationship between Severity of Physical Impairment and Costs of Care in an Elderly Population

https://doi.org/10.1067/mgn.2000.107134Get rights and content

Abstract

The cost-effective use of long-term care options in a resource-scarce environment depends on targeting services to people who could be cared for most efficiently in specific settings. This study identified subgroups with a high potential for reduced costs of care in different settings by using some measures of physical impairment. The findings indicated that, for elderly people with physical impairment scores below 12 (possible range of 0 to 14), the cost of care was lower with home care than in the nursing home setting. However, for elderly people with physical impairment scores above 12, the cost of care was higher with home care than in a nursing home. (Geriatr Nurs 2000;21:102-6)

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.

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