Removing the Financial Barriers to Home-Based Medical Care for Frail Older Persons

      Approximately 7.5 million adults in the United States (US) have difficulty making office visits to physicians, either because they are homebound (2 million) or need transport and other assistance (5.5 million).
      • Ritchie C.S.
      • Gallopyn N.
      • Sheehan O.C.
      • et al.
      Challenges and adaptations among home-based primary care practices: lessons for an ongoing pandemic from a national survey.
      Although many would qualify for care in a nursing home, these individuals and their families often prefer home-based care, which includes (1) home-based medical services (ie, medical and mental health providers and therapeutics) and (2) home health care (ie, nursing, allied health, rehabilitation, social services, and personal care). Providing financial resources and support services for home-based long-term care is, however, challenging. Medical care, rehabilitative care, personal care and supervision, laboratory services, behavioral and family care, and palliative services must all be available and aligned.
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        • Ritchie C.S.
        • Gallopyn N.
        • Sheehan O.C.
        • et al.
        Challenges and adaptations among home-based primary care practices: lessons for an ongoing pandemic from a national survey.
        J Am Med Dir Assoc. 2021; 22: 1338-1344
        • Zimbroff R.M.
        • Ornstein K.A.
        • Sheehan O.C.
        Home-based primary care: a systematic review of the literature, 2010‒2020.
        J Am Geriatr Soc. 2021; 69: 2963-2972
        • Kim C.O.
        • Jang S.N.
        Home-based primary care for homebound older adults: literature review.
        Ann Geriatr Med Res. 2018; 22: 62-72
        • Reckrey J.M.
        • Yang M.
        • Kinosian B.
        • et al.
        Receipt of home-based medical care among older beneficiaries enrolled in fee-for-service Medicare.
        Health Aff (Millwood). 2020; 39: 1289-1296
        • Yao N.
        • Ritchie C.
        • Camacho F.
        • Leff B.
        Geographic concentration of home-based medical care providers.
        Health Aff (Millwood). 2016; 35: 1404-1409
        • Schuchman M.
        • Fain M.
        • Cornwell T.
        The resurgence of home-based primary care models in the United States.
        Geriatrics (Basel). 2018; 3: 41
        • Liu B.
        • Ritchie C.
        • Ankuda
        • et al.
        Growth of fee-for-service Medicare home-based medical care within private residences and domiciliary care settings in the US, 2012‒2019.
        J Am Med Dir Assoc. 2022; 23: 1614-1620
        • Kane R.A.
        Expanding the home care concept: blurring distinctions among home care, institutional care, and other long-term-care services.
        Milbank Q. 1995; 73: 161-186
        • Zimmerman S.
        • Gruber-Baldini A.L.
        • Sloane P.D.
        • et al.
        Assisted living and nursing homes: apples and oranges?.
        Gerontologist. 2003; 43: 107-117
        • Wilson K.B.
        Historical evolution of assisted living in the United States, 1979 to the present.
        Gerontologist. 2007; 47: 8-22
        • Beeber A.S.
        • Zimmerman S.
        • Madeline Mitchell C.
        • Reed D.
        Staffing and service availability in assisted living: the importance of nurse delegation policies.
        J Am Geriatr Soc. 2018; 66: 2158-2166
        • Zimmerman S.
        • Carder P.
        • Schwartz L.
        • et al.
        The imperative to reimagine assisted living.
        J Am Med Dir Assoc. 2022; 23: 225-234
        • Melnick G.A.
        • Green L.
        • Rich J.
        House calls: California program For homebound patients reduces monthly spending, delivers meaningful care.
        Health Aff (Millwood). 2016; 35: 28-35
        • Gandhi T.
        • Bonner A.
        • Muething S.
        • et al.
        As home care expands, let's make it safer for everyone. Health Affairs Forefront; March 20, 2019.
        • Grabowski D.C.
        The cost-effectiveness of noninstitutional long-term care services: review and synthesis of the most recent evidence.
        Med Care Res Rev. 2006; 63: 3-28
        • Wysocki A.
        • Butler M.
        • Kane R.L.
        • et al.
        Long-term services and supports for older adults: a review of home and community-based services versus institutional care.
        J Aging Soc Policy. 2015; 27: 255-279
        • Weissert W.G.
        • Cready C.M.
        • Pawelak J.E.
        The past and future of home- and community-based long-term care.
        Milbank Q. 1988; 66: 309-388
        • Ticona L.
        • Schulman K.A.
        Extreme home makeover—the role of intensive home health care.
        N Engl J Med. 2016; 375: 1707-1709
        • Nogués X.
        • Sánchez-Martinez F.
        • Castells X.
        • et al.
        J. Hospital-at-home expands hospital capacity during COVID-19 pandemic.
        J Am Med Dir Assoc. 2021; 22: 939-942
        • Loveland P.M.
        • Reijnierse E.M.
        • Island L.
        • et al.
        Geriatric home-based rehabilitation in Australia: Preliminary data from an inpatient bed-substitution model.
        J Am Geriatr Soc. 2022; 70: 1816-1827
        • Bharadwaj S.
        • Bruce D.
        Effectiveness of 'rehabilitation in the home' service.
        Aust Health Rev. 2014; 38: 506-509
        • Leong M.Q.
        • Lim C.W.
        • Lai Y.F.
        Comparison of hospital-at-home models: a systematic review of reviews.
        BMJ Open. 2021; 11: e043285
        • Hokenstad A.
        More care at home: the challenge of creating viable community alternatives to nursing home care.
        Care Manag J. 2005; 6: 9-14
        • Aggarwal N.
        • Sloane P.D.
        • Zimmerman S.
        • Ward K.
        • Horsford C.
        Impact of COVID-19 on structure and function of Program of All-Inclusive Care for the Elderly (PACE) sites in North Carolina.
        J Am Med Dir Assoc. 2022; 23: 1109-1113.e8
        • Jamieson A.
        Home care in old age: a lost cause?.
        J Health Polit Policy Law. 1992; 17: 879-898
        • Stall N.
        • Nowaczynski M.
        • Sinha S.K.
        Systematic review of outcomes from home-based primary care programs for homebound older adults.
        J Am Geriatr Soc. 2014; 62: 2243-2251
        • Wysocki A.
        • Butler M.
        • Kane R.L.
        • et al.
        Long-term Care for Older Adults: A Review of Home and Community-based Services Versus Institutional Care.
        Agency for Healthcare Research and Quality (US), 2012 (Report No.: 12(13)-EHC134-EF. PMID: 23256217)
        • Konetzka R.T.
        The hidden costs of rebalancing long-term care.
        Health Serv Res. 2014; 49: 771-777
        • Chan C.S.
        • Davis D.
        • Cooper D.
        • et al.
        VA home-based primary care interdisciplinary team structure varies with Veterans' needs, aligns with PACE regulation.
        J Am Geriatr Soc. 2021; 69: 1729-1737
        • Yang M.
        • Thomas J.
        • Zimmer R.
        • et al.
        Ten things every geriatrician should know about house calls.
        J Am Geriatr Soc. 2019; 67: 139-144
        • LaFave S.
        • Drazich B.
        • Sheehan O.C.
        • et al.
        The value of home-based primary care: qualitative exploration of homebound participant perspectives.
        J Appl Gerontol. 2021; 40: 1611-1616
        • Chua C.M.S.
        • Ko S.Q.
        • Lai Y.F.
        • et al.
        Perceptions of hospital-at-home among stakeholders: a meta-synthesis.
        J Gen Intern Med. 2022; 37: 637-650