Abstract:

As need for home care services expands it becomes increasingly important to scrutinize the use of such services. The identification of patient characteristics associated with relatively costly home care is fundamental to shaping future reimbursement policies for individuals using home care. This study estimates effects of elderly patients' characteristics on the probability of use and costs of home health services, with particular attention to the effects of urinary incontinence. The focus on incontinence derives from the hypothesis that this particular set of problems increases human suffering and may raise needs for and costs of home care. At the same time, such problems appear to be responsive to appropriate and timely intervention. Patient specific data for this research was obtained from the Connecticut Department on Aging, Department of Income Maintenance, and from the Health Care Financing Administration. Previous research has lacked patient specific data and has been limited to single payor data. A retrospective cohort design was used to examine the use of home care among a population of low-income persons receiving services from an integrated, case managed system, affording a unique opportunity to study in depth the varieties of home care services used as well as the public expenditures they entail. Multivariate analysis was carried out to estimate effects of independent variables on indicators of use and costs of home care services, controlling for individual characteristics as well as regional long-term care supply factors. Incontinence of urine is demonstrated to result in greater likelihood of use of home care service, in particular services from paraprofessionals. Among users of home care service urinary incontinence results in use of greater amounts of these services resulting in significantly greater public costs for home care services overall.