Home-Based Clinical Services Are Safe and Effective But Underutilized

July 13, 2023


Contact: Ellen Mullally

Home-based clinical services are a patient-centered, safe, and effective way to meet the clinical care needs of older adults with complex medical needs. However, a new study in the July issue of JAMDA indicated that many individuals who need and could benefit from such services don’t receive them.

In Use of Home-based Clinical Care and Long-Term Services and Supports Among Homebound Older Adults, the authors used data from the 2015 National Health and Aging Trends Study and found that only about 30% of homebound Medicare beneficiaries included in the study received any home-health services, the most common being some form of home-based clinical care. At the same time, 80% received some home-based long-term services and supports (LTSS), such as assistive devices and paid caregiving. The authors said those who received home-based clinical care were more likely to receive home-based LTSS.

Use of the most common types of home-based LTSS—assistive devices, home modifications, paid caregivers, and high family caregiving—was similar “regardless of the type of home-based clinical care used,” the authors said.

“While our findings describe…the need for home-based care, services, and supports, we see that many types of home-based services were used at low frequency,” the study authors said. “This confirms previous work indicating that forms of home-based clinical care are underutilized and suggests that several types of home-based LTSS—such as home-delivery meals—may be underutilized as well.”

Affordability of services may be an issue, they suggested, “especially given supports and services are covered by a patchwork of payers with substantial geographic variation.”

Future studies, the study team offered, should examine how various factors shape the receipt of home-based services and supports. At the same time, they said additional studies should consider “the wide range of ways people access home-based LTSS and prompt CMS to expand efforts to improve clinical and long-term integration for the larger population.”

This study was conducted by researchers at the Icahn School of Medicine at Mount Sinai, New York, NY; LeadingAge LTSS Center at UMass Boston, Washington, DC; Massachusetts General Hospital, Boston, MA; Johns Hopkins University School of Medicine, Baltimore, MD; and Johns Hopkins University School of Nursing, Baltimore, MD.

Get more information on the findings above and more details about the study. To contact the researchers or JAMDA editors for an interview, please email emullally@paltc.org.





JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles, including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.