Chronic Conditions, Cognitive Impairment Drive Time
Seniors Need Home Health Care
People are living longer, yet many are living with
one or more chronic diseases and a decline in cognitive ability, which
has major implications for home health care agencies
April 27, 2009 - Multiple chronic health conditions
and some degree of cognitive impairment are common among senior citizens
(age 65 and older) in Medicare home health care, and lead to longer
periods of home health care use. A new study from the VNSNY Center for
Home Care Policy & Research also finds that for each additional chronic
condition, there is an increase in the number of days that older adults
spend in home care.
The findings are reported in the current issue of
the Journal for Healthcare Quality.
In what claims to be the first study to examine how
chronic health conditions and cognitive impairment impact the duration
of home health care use, researchers found that the vast majority of
home health care patients are 65 or older (87 percent).
Nearly 39 percent of home care patients are 75 to
85 years old, and 22 percent are age 85 or older.
“People are living longer, yet many are living with
one or more chronic diseases and a decline in cognitive ability, which
has major implications for home health care agencies, clinicians and
paraprofessionals,” said Christopher Murtaugh, Ph.D., Principal
Investigator and Associate Director of the VNSNY Center for Home Care
Policy & Research.
“Clinically complex patients present health care
planning and management challenges for home health care agencies. More
research-based evidence specific to older home care patients is
necessary to help home care agencies effectively improve health outcomes
for the patients they serve,” said Dr. Murtaugh.
Three quarters of home health care patients age 65
and older were reported to have at least one chronic condition that
contributes to the need for home health care. One quarter of the
patients had two chronic conditions, and 17 percent had three or more,
according to the study.
The top five chronic illnesses were hypertension
(30 percent); diabetes (21 percent); arthritis and musculoskeletal
diseases (16 percent); heart failure (13 percent); and chronic pulmonary
disease (12 percent).
The researchers found that the more chronic health
conditions patients had, the more days of home care they used. For
example, patients who had hypertension plus three or more other chronic
conditions, such as diabetes, heart disease, and arthritis, had nearly
22 days more (78 days total) of home care on average than patients with
only hypertension (56 days total).
In hospital and other inpatient settings, “length
of stay” is typically used as a measure of resource use.
When older home health care patients had cognitive
impairment and at least one chronic condition, the length of their home
health care stay also increased. For example, patients with hypertension
and cognitive impairment used home health care for 20 days longer than
patients without cognitive impairment.
Over a third (36 percent) of home care patients had
some degree of cognitive impairment, according to the study.
“Mild” impairment was found in nearly a quarter of
the patients (24 percent), and “moderate to severe” impairment was
reported for 13 percent of home care patients. Cognitive impairment has
significant implications for home health care patients’ clinical
outcomes and their ability to manage their own care.
On average, older adults used home health care for
53 days. The majority (81 percent) of the home health care patients age
65 and up were discharged from home care within 60 days of admission.
Only 1 percent of the patients received home care for more than a year.
The study’s authors say their findings support a
critical need to address two key policy and practice issues to improve
home health care for patients with clinically complex conditions:
● Chronic conditions and cognitive function
should be accurately assessed and recorded on the required Centers for
Medicare & Medicaid’s (CMS) Outcome and Assessment Information Set
(OASIS).
Consideration should be given to incorporating
a chronic disease checklist into the OASIS admission assessment and
including the new methods for rigorously assessing mental status
currently being tested in a CMS demonstration.
● Better tools are needed to provide effective
care to people with multiple chronic conditions and cognitive
impairment. Clinical practice guidelines and evidence-based practice
recommendations must address the complexity associated with multiple
chronic conditions, especially in older adults.
The nation’s current focus on chronic health
conditions in the health care system should be paralleled in quality
improvement and quality assurance efforts in home health care.
To conduct the study, researchers determined the
ages of home health care patients, using OASIS data on 6.5 million home
care discharges from Medicare-certified home health care agencies from
2004 through 2005.
Once they determined the ages of home care patients
upon admission, the researchers used just the data on 5.6 million
discharges for patients age 65 and older.
Background Information:
“Complexity in Geriatric Home Healthcare,” by Christopher Murtaugh,
Ph.D., Timothy Peng, Ph.D., Annette Totten, Ph.D., and Beth Costello,
M.A., of the VNSNY Center for Home Care Policy & Research; Stanley
Moore, B.S., Independent Contractor; and Hakan Aykan, Ph.D., Assistant
Secretary for Planning and Evaluation, U.S. Department of Health and
Human Services, was published in the Journal for Healthcare Quality
March/April 2009.
The
Center for Home Care Policy & Research conducts scientifically
rigorous research to promote the delivery of high quality,
cost-effective care in the home and community and support informed
decision making by policy makers, payers, managers, practitioners, and
consumers of home and community based services. The Center is part of
the
Visiting Nurse Service of New York (VNSNY) and conducts research
that is broadly applicable to real-world home care settings. VNSNY is
the largest not-for-profit home care agency in the United States.
