Home-based clinical care and long-term services and supports (LTSS) are beneficial to homebound older adults, but many do not use these services, a study in the Journal of the American Medical Directors Association found.
The study identified three distinct groups of patients using home-based services: high clinical with LTSS (8.9%), home health only with LTSS (44.5%) and low care and services (46.6%). Although researchers found that home-based clinical care and LTSS use was common among homebound adults, not one of these groups received high levels of all care types. The study included 974 homebound older adults who had at least 12 months of fee-for-service Medicare claims data prior to their interviews for the study.
A lack of funding and differing access to home- and community-based services are reasons for the low uptake of services, according to study co-author Robyn Stone, DrPH, who is LeadingAge senior vice president and LeadingAge LTSS Center @UMass Boston co-director.
“Access to home- and community-based services varies tremendously by state and locale,” Stone told McKnight’s Home Care Daily Pulse via email. “Typically, funding is cited as a barrier for expanding access. For those low-income people who qualify for Medicaid, HCBS is provided through waivers and states vary in what is available and covered. For those who need to pay for services out of pocket, many simply cannot afford to purchase formal services.”
The study found that about 30% of the study sample received home-based clinical care. Approximately 80% of the study sample received home-based LTSS in a variety of categories, including paid helper assistance with a functional task and transportation assistance.
Stone listed a number of benefits LTSS provides to homebound older adults.
“LTSS provides assistance with activities of daily living (e.g., eating, bathing, toileting, etc.) and instrumental activities of daily living (shopping, housekeeping, mobility),” she said. “LTSS helps people to function in their environment and the community, and the potential for continued health and well being is greatly enhanced. LTSS also helps with emotional support, connectedness and addressing social isolation.”
Still, many homebound adults do not access it.
“Many who likely need and could benefit from such services do not receive home-based support,” the study said.