HOME MODIFICATIONS, ASSISTIVE DEVICES CAN CUT HOMECARE COSTS
SAVINGS ARE QUADRUPLED, STUDY FINDS
The costs of caring for chronically ill elders could decrease significantly if home modifications and assistive technology were used to allow frail elders to remain living independently in their homes. A newly released study found that frail older adults who were aided with home modifications and assistive devices intended to ensure their safety and independent functioning spent four times less on homecare services, nursing home care and hospitalizations than other impaired elders. In addition, older people who were able to stay in their homes comfortably and safely reported higher functional performance and less pain than those who did not receive as many assistive devices and adaptive alterations of their homes.
The results of the study, "Effectiveness of Assistive Technology and Environmental Interventions in Maintaining Independence and Reducing Home Care Costs for the Frail Elderly," were published in the MayJune 1999 issue of the Archives of Family Medicine. The study also was discussed at the recent San Francisco conference of the National Chronic Care Consortium by William Mann, director of the University at Buffalo's Center for Assistive Technology (cat), whose Rehabilitation Engineering Research Center on Aging conducted the study.
HIGHER SERVICE COSTS
The research team compared a treatment group, provided with all the devices and home modifications they needed, with a control group that received "usual care services," or those covered under Medicare, Medicaid and programs of the Older Americans Act. The initial expenditure for participants receiving the additional help averaged $2,233 per person. When service charges were tallied, though, researchers discovered their "most dramatic results," Mann said. The treatment group spent only $5,630 on nursing home care and hospitalizations compared to a whopping $21,847 for the control group. Further, those provided assistance accounted for only $98 for in-home nursing and care manager visits, compared to $855 for the control group. "While we hypothesized overall lower costs, we didn't expect to see an almost fourfold difference," Mann said.
"This was the first study of its kind, using the most powerful tool we have as researchers, the randomized controlled clinical trial," Mann added. "A study like this has to influence policy and change the reimbursement structure currently out there. As people face the effects of getting older, including chronic illness, we have to give them the tools to remain independent. It will save money in the long run." The investigators followed the progress of 104 older home-based frail elders (52 each in the treatment and control groups) with physical disabilities who lived in western New York.
Although researchers found they couldn't "halt functional decline, we could retard the rate of decline and also found that the control group had an increase in perceived pain over the 18 months of the study," Mann said.
Many of the assistive devices provided by Mann's study are not currently covered under private insurance or Medicaid. These include magnifying glasses, remote devices to turn lights on and off in the house, and bath benches. Home modifications include things such as adding ramps and lowering cabinets. An initial home assessment can, for example, lead to removing throw rugs and other common fall hazards.
Other kinds of devices that could reduce costs to those with chronic illness are videoconferencing computers to enable frail elders to keep in frequent contact with healthcare professionals; homecare monitoring systems to remind patients to take medication; and wireless devices that record the temperature and blood pressure of elders and transmit the information over telephone lines to doctors.
In their conclusion, the researchers quoted former U.S. Assistant Secretary of Aging Fernando Torres-Gil, now of the University of California, Los Angeles, and colleague Linda Wray of ucla: "The current overreliance on high-cost, high-technology interventions may delay mortality while increasing morbidity. Accordingly, preventing or postponing morbidity is often cited as an important public health goal."
The four-year Buffalo study, supported by the U.S. Administration on Aging and the aarp Andrus Foundation, will continue to gather data and evaluate results every six months. In addition to the recently released report, the center is conducting a longitudinal study of the coping strategies of frail elders.
For more information, contact the Rehabilitation Engineering Research Center on Aging at (800) 628-2281, or visit the Center for Assistive Technology Web site at www.wings.buffalo.edu/go?cat for products, videos and booklets.
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