Home-Based Senior Care Program Has Limited Benefits

Home-Based Senior Care Program Has Limited Benefits
TUESDAY, Dec. 11 (HealthDay News) -- An intensive, home-basedprogram to improve medical care for low-income seniors produced mixedresults, a geriatrics team reports.
Failure to get better outcomes indicates the need for a new analysis ofhow Medicare pays for the care for older Americans, experts said.
"We were able to stabilize medical care for these people, who oftenhave an up-and-down experience with medical care," said Dr. Steven R.Counsell, a professor of geriatrics at Indiana University and lead authorof a report in the Dec. 12 issue of the Journal of the American MedicalAssociation. "The main thing that did not change was physicalfunction. The program did not prevent decline."
Some improvements were evident in the two-year course of the program,which included care management by nurse practitioners and social workerswho collaborated with a primary-care physician and a geriatricsinterdisciplinary team guided by protocols for common conditions ofaging.
Better improvement in general health, vitality, social functioning andmental health were noted in the 474 older people, as compared to a groupof 477 getting usual care in community-based medical centers. Emergencyroom visits decreased for the intervention group, but the death rate didnot decline.
The program was run under Medicare, which placed limits on how it wasfinanced, Counsell said. In general, Medicare pays for specific treatmentsof specific conditions, so that most of the efforts to coordinate carewere not reimbursed, he said.
"But we were hoping that this kind of coordinated care would showimprovement in many areas," Counsell said.
The program results indicate a need for a basic revamping of Medicarefinancing, said Dr. David B. Reuben, a professor of medicine at theUniversity of California, Los Angeles, who wrote an accompanyingeditorial.
"Medicare, for the most part, pays for physical services," Reuben said."If care is provided that doesn't fall into the category of one of thoseservices, it isn't paid for. So, coordination of special services is notreimbursed."
The partial success of the program indicates that "a new model isachievable" under Medicare, Reuben said, "but the time is ripe for athorough re-evaluation of how Medicare pays for services. It really needsto be freshened up. We can have fee for service, but we have places wherewe must fill in the gaps, and one of the big gaps is coordination ofcare."
Counsell said he and his colleagues are going through data collected inthe program to determine whether it makes sense financially. "Armed withsome further information and a cost analysis, we are looking at how muchthe program cost and how much was saved and who benefits the most," hesaid.
Elements of the program could be adapted for use with specialpopulations, such as nursing home patients and those with chronicillnesses, Counsell said, working through organizations that delivermanaged care to selected groups.
"There has to be a different infrastructure," Reuben said. "If themethod of financing is good, good infrastructure tends to follow."
More information
Details on health care for the elderly is provided by the American GeriatricsSociety.