FCRP Policy Statement

• Because of shortened hospital stays, patients who meet criteria may receive skilled home care (SHC) services. They include; nursing care, physical and occupational therapy, as well as assistance from home health aides and social workers To receive services, patients must be confined to home, have no caregiver, and/or require complex nursing care in order to recover from their illness.
• SHC services are a rapidly increasing share of health care costs. Few evaluations of these programs and how they affect patient outcomes are available.
• To better understand who receives these services, family caregiver researchers from Michigan State University followed 611 patients, 55 years of age and older (mean age of 73) from hospital to home and compared those who received one or more skilled. services with those who did not. To be selected, patients had new needs for assistance to remain at home following discharge from the hospital. Needs included; assistance with self care, meal preparation, assistance with shopping as well as medical equipment, wound care, or physical therapy. All patients were interviewed in their homes within 30 days of hospital discharge. The goal of this research was to determine the extent to which the need based criteria, in the Medicare guidelines, could predict who received SHC services and the number of services received.

Three hundred and sixty four of the 611 patients (60%) received at least one SHC service visit.

Factors Related to Patient Receipt of SHC Services:

• Each year of age, there was more receipt of sources. 4 or more coexisting medical diagnoses were 3.5 times more likely to receive SHC services. 1-2 dependencies in self care activities and 1-3 medical equipment needs were 3.5 times more likely to receive SHC services. 3-5 dependencies in self care activities and 1-5 medical care tasks (MCTS) were 11 times more likely to receive SHC services.
• Heart and related circulatory problems and cancer were 2.75 and 2.15 times more likely to receive services.
• Therefore, those with greater functional deficits and medical treatments were more likely to receive skilled care services.

Factors Unrelated to Patient Receipt of SHC Services:

• Living alone or only with an elderly caregiver did not predict receipt of SHC services.
• Homebound states (unable to get around in house or community) were not related to receipt of SHC services received.

Number of SHC Visits Patients Received:

Patient age, coexisting conditions, self care, medical tasks needs, diagnoses, living arrangements, or the combination of these factors were not related to the number of visits patients received from SHC services.

Policy Implications:

• Identification of patients' needs for SHC services, by hospital discharge planning and communication of referral processes to SHC agencies needs to be streamlined. Many patients who meet eligibility criteria do not receive SHC services.
• Family's capacity to provide care at home needs to be evaluated as a component of need for SHC services.
• RETROSPECTIVE DISAPPROVAL OF PAYMENT FOR VISITS MADE BY SHC AGENCIES MAY CAUSE SERVICE DECISIONS BASED ON WHETHER REIMBURSEMENT IS POSSIBLE RATHER THAN UPON PATIENT NEEDS FOR CARE., (THIS IS A CRITICAL ISSUE TO BE ASSESSED IN SHC SERVICES.)
• Outcome studies are needed to determine if SHC servi6es enhance patients' recovery, and for which types of medical problems are SHC services most important, and to what extent do SHC services reduce readmissions to hospitals.

Finally, is the current prospective payment system cost effective? Are shorter length of stays leading to more SHC services, higher rates of readmission, and longer periods of recovery for older patients?

This research was supported by Grant #2 ROI AM584 "Caregiver Responses to Managing Elderly Patients at Home,* funded by the National Institute on Aging, C.W. Given and Barbara A. Given, Principal Investigators. Correspondence should be addressed to Dr. C.W. Given, B-100 Clinical Center, Department of Family Practice,Michigan State University, East Lansing, MI 48823-1313 (1-800-654-8219 or 517-353-3843).