House Calls: The Impact of Home-Based Care for Older Adults With Alzheimer’s and Dementia

Abstract

Older adults with Alzheimer's/dementia have high health care costs; they may benefit from home-based care, but few have home visits. This article describes a home-based care program for frail elders, including those with Alzheimer's/dementia. Descriptive statistics are provided for Medicare-enrolled program participants and matched controls with Alzheimer's/dementia on expenditures along six services: skilled nursing facility, inpatient acute, physician, home health, hospice, and social services. Cases with dementia were significantly more likely to have home health and hospice expenditures than controls, suggesting potential for the program to improve end-of-life care. Very few cases or controls had any social service expenditures. Social workers should advocate for the expanded role of home-based care for older adults with dementia and for increased Medicare reimbursement of social work services.

Palliative care for people with dementia living at home: A systematic review of interventions

“…We identified three studies evaluating specialist palliative care services 19–21 and five evaluating non-specialist palliative care interventions (Table 2). 22–27 One study on non-specialist palliative care intervention was reported in two articles. 22,23 Four of the studies presented evidence from the United States, 19,20,24,25 two from Italy, 22,23,27 and one each from the United Kingdom 26 and Japan.…”

“…22–27 One study on non-specialist palliative care intervention was reported in two articles. 22,23 Four of the studies presented evidence from the United States, 19,20,24,25 two from Italy, 22,23,27 and one each from the United Kingdom 26 and Japan. 21 Of the studies, four were RCTs, 21–24 two retrospective case-control studies, 19,25 one retrospective cross-sectional study 20 and one with an unclear study design.…”

“…Overall, five of the eight studies were considered of weak quality, particularly due to high risk for selection bias, inability to achieve blinding and inability to clearly measure and/or report the integrity and consistency of the intervention (Table 2). 19,20,22,23,25,27 Of these studies, three did not control for confounders and used inappropriate data analysis techniques, 20,22,23,27 while the other two studies took potential confounders into account by using propensity score matching to identify control group and analysed the data appropriately. 19,25 These five studies received moderate ratings for using health/medical records as the source of data, but the procedures for data collection were inadequately reported.…”

“…24 The other three studies aimed to bring care that is usually offered in institutions or hospitals to patients’ homes. One of these studies evaluated the medical care offered by House Calls 25 and two evaluated the diagnostic and therapeutic treatments for acute illnesses offered by Home Hospitalisation Service. 22,23,27…”

“…The authors attributed the relatively low social services utilisation to the limited financial reimbursement available for social services. 25…”