Health Care, Access, Insurance
Home healthcare service utilization among people aged 65 years and older and its effect on hospitalization and emergency room visits.
(School of Public Health (UMD) HLSA Doctoral Student)
Background: Adults aged over 65 years account for 15% of Accident and Emergency (A&E) attendances (Downing & Wilson, 2005). Because older people use substantial health care services, age-related chronic diseases that comes with aging contributes to the burden of adult care and subsequently increases the cost and utilization of health care services among older adults. There is growing evidence (Wanles, 2006) that admissions, ER visit and length of hospital stay could be reduced by a range of social care intervention, such as home-based and community-based care (e.g. home health care and adult day care). Furthermore, home and community-based service (HCBS), in addition to reducing health service utilization, promote social contacts, which can positively affect health behavior and well-being of older adults (Greaves & Farbus, 2006). Objective: This study aims to assess if and how home health care service (HHCS) utilization contribute to ED and inpatient hospitalization among adults aged 65 and older. I hypothesize that users of HHCS will have reduced admission and ER visit. Method: Using the 2014 medical expenditure panel survey (MEPS) data (n=4,001), logistic regression of all data elements was conducted to explore impact of homehealth care on subsequent service utilization and what factors influences homehealth use. Results: Findings indicated that of all 4,001 who were included in the analysis 12.4% utilized HHCS, 43% had ER visit and 42% were admitted. This study found that among those who utilized HHCS (496), only those who were serviced by home health agencies (HHA) have increased odds of ER visit (P< 0.01) and inpatient admission (P<0.01).Findings further indicate that perceived health status, marital status, chronic health conditions, and poverty level predicts HHA utilization (P<0.05). Conclusion: While these finding is counter-intuitive some plausible explanation is that those who utilized HHA are either sicker or that HHA is a way to promptly identify deteriorating health thus prompting intervention (increased utilization) that allow patients to live longer, delay institutionalization and improve overall quality of life. Also, chronic conditions which may have severe long-term consequences like cardiovascular morbidity, and cost savings among these patients due to secondary preventive measures like home health care may not be realized until later in the disease. Future research effort is needed to further explore why there is low utilization of homehealth services and to follow participants in other to explore long term impact of home healthcare on chronic condition that seniors encounter.
Importance to public health: