Shannon GR (VA Greater Los Angeles HSR&D Center of Excellence)
Yip JY (SCAN,Long Beach, CA)
Wilber KH (University of Southern California)
The number of veterans 85 years and older requiring long-term care (LTC) health services is expected to increase from about 870,000 to approximately 1.3 million over the next decade. Home and community-based care for chronically ill veterans is increasing. We present a study examining the effect of improved access to six categories of home and community-based services (HCBS) on utilization of high cost, medical services (hospital and emergency room) for community-dwelling frail, older adults.
Members of a Medicare-risk HMO (n=823), deemed eligible for this trial using a frailty algorithm, were randomly assigned to the Care Advocate (CA) intervention (n=389) or to usual care (n=434). Change in health care utilization (primary care and specialist encounters, hospital days, hospital admissions, and ER encounters) was measured from 12 months prior to 12 months during and 12 months post-intervention. Multinomial logistic regressions compared change in utilization between study groups, controlling for endogenous variables (months in study and died during the measured period). Chi-square and t-tests determined significant differences in mortality between CA members and controls during and post intervention.
We found no significant differences by age, gender, diagnoses, or medical service utilization at baseline. CA members were 74% more likely to have increased utilization of both primary care (p = .014) and specialists (p = .035) and were 43% less likely than controls to have increased hospital admissions (p = .048), compared to no change. Further, CA members had significantly lower mortality during the intervention (CA= 6.7%, control = 15.2%; p-value = .000).
Significant reductions in high-cost hospital admissions and decreases in mortality for CA members during the intervention period suggest that greater access to HCBS may influence the cost of care and well-being of community-dwelling, older adults in need of long-term and chronic care services.
In October, 2001 a VA directive required that VA facilities provide access to noninstitutional adult day care, geriatric evaluation, and respite care for veterans in need of LTC services. Future analysis should consider which combination of HCBS would yield the greatest benefit for community-dwelling veterans.