A large number of Medicare beneficiaries are too ill to leave their homes and not receiving appropriate medical care, according to findings published recently in JAMA Internal Medicine.
“The homebound population of older adults is 50 percent larger than the nursing home population in this country but almost completely invisible,” says senior author Sarah Szanton, PhD, ANP, FAAN, associate professor and PhD program director at the Johns Hopkins School of Nursing. “Only 11 percent receive homebound medical care, and the others may receive no care or intermittent care.”
Out of all community-dwelling Medicare beneficiaries, about 5.6% were homebound as of 2011, the study reports. These figures equate to more than 395,000 totally homebound seniors and more than 1.5 million who were partially homebound, meaning they could leave the home only with assistance or had difficulty leaving the home.
These homebound individuals were more likely to be older, female and non-white, with less education and income than the average Medicare beneficiary.
“As Medicare considers home health payment reform and changes in the methods of paying for medical care, the development and dissemination of home-based primary care and associated quality frameworks are essential,” they wrote. “Much of what we know about homebound individuals is based on studies of those who receive home health care services or home-based primary care. Combining survey data with administrative data on service use may inform the development of improved clinical services for homebound individuals.”
The findings are based on an analysis of cross-sectional data from the National Health and Aging Trends Study collected in 2011. In addition to Johns Hopkins School of Nursing, authors were affiliated with a variety of institutions, including Icahn School of Medicine at Mount Sinai in New York City and the Geriatrics Division at the Department of Medicine at the University of California, San Francisco.