Home Health Care for Acutely Ill Elderly Populations

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Home Health Care for Acutely Ill Elderly
Populations

• Quicker, Cheaper, Better?
• Lyn OBrien, MS, RN, ANP
• Geriatric Home Care Nurse Practitioner,
  Deaconess-Waltham Hospital, Waltham, MA
• Carl W. Nelson , PhD
• Associate Professor, Northeastern University,
• Boston, MA

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Challenges

• Having armies of home care workers traveling
  to geographically disparate locations to visit
  patients requires more resources than would be
  needed to care for the same patients, if they
  were concentrated in half-empty hospitals.
• Uwe Reinhardt, (New York Times, 4/26/00).

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Challenges

• home care has been burdened by unrealistic
  expectations, inadequate attention to the
  specific outcomes achievable for various
  subgroups, and, to some extent, poor management
  due to a lack of understanding of the nature of
  its cost structure and lack of adequate attention
  to cost-saving strategies born of a missionary
  sense that net savings would be automatic.
• Weissert, Health Services Research, 20(4)

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Heightened Risks

• Hospitalized elders experience medical injury two
  to four times as often as patients in other age
  groups
• The incidence of nosocomial infections in older
  adults ranges from 5.9 to 16.9 per 1000 hospital
  days
• patients exposed to high ICU workload were more
  likely to die than those exposed to lower
  workload, regardless of health risks
• profound deterioration in gait during
  hospitalization generalized deconditioning
• rate of fall from approximately 3.8 to 7.0 per
  10000 patient-days for older adults

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Caregiver Burden

• Between 7 and 23million people are informal
  caregivers 45-190 billion per year if replaced
  by paid professional staff
• Caregivers sacrificed an average 566,000 in
  wages, 67,000 in pension benefits, and 26,000
  in Social Security benefits. Additionally,
  caregivers spent an average 20,000 on food,
  transportation, housing.
• Five in six caregivers were forced to quit,
  retire prematurely, cut back their work hours, or
  take sick time, vacation time, or a leave of
  absence from work. Three-quarters of the
  caregivers suffered a health problem related to
  being a caregiver.

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Too Much Focus on Costs?

• Cost-effectiveness is not the only rationale
  for home care. The best argument for home care
  is that it is a humane and compassionate way to
  deliver health care and supportive services.
  Home care reinforces and supplements the care
  provided by family members and friends and
  maintains the recipients dignity and
  independence, qualities that are all too often
  lost even in the best institutions. Further,
  home care allows patients to take an active role
  in their care, becoming members of a
  multidisciplinary health care team.
• ( NAHC, 2000)