A study published May 26 in JAMA Internal Medicine says a large “invisible” population of older adults are not receiving the care they need because they aren’t strong or well enough to leave their homes, according to a Johns Hopkins School of Nursing news release.
“The homebound population of older adults is 50% larger than the nursing home population in this country but almost completely invisible,” senior author Sarah Szanton, PhD, ANP, FAAN, associate professor and PhD program director at Johns Hopkins SON, Baltimore, said in the news release. “Only 11% receive homebound medical care, and the others may receive no care or intermittent care.”
In the study “The Epidemiology of the Homebound Population in the United States,” Szanton, Katherine A. Ornstein, PhD, MPH, instructor at the Icahn School of Medicine at Mount Sinai, N.Y., and colleagues look at the community-dwelling Medicare population, which they estimate to be about 2 million people.
They explain that most older adults want to age at home, but with the ability to come and go as they wish. Being homebound means being trapped, unable to leave without considerable help. “This lack of capacity may be partially or fully remediated by the availability of personal assistance,” the authors wrote in the study.
According to the study, the prevalence of the homebound was 5.6%, including an estimated 395,422 people who were completely homebound and 1,578,984 who were mostly homebound in 2011. Completely homebound individuals were more likely to be older, female, nonwhite and have less education and income than the nonhomebound population, to have more chronic conditions, and to have been hospitalized in the last 12 months. Only 11.9% of completely homebound individuals reported receiving primary care services at home. Some programs are in place to help this population. According to the release, the Patient Protection and Affordable Care Act has spurred the development of new health service delivery models to serve the homebound, including the Independence at Home demonstration program and multidisciplinary home-based primary care programs that deliver medical and social services, and CAPABLE – for Community Aging in Place, Advancing Better Living for Elders – which involves home visits with an occupational therapist, an RN and a handyman who work together with older adults to identify mobility and self-care issues in their homes and inexpensively fix or modify them.
“We find that working with older adults on their own goals while making small changes to the home environment is powerful medicine,” Szanton, who launched the CAPABLE program in Baltimore and has since seen it piloted in Michigan among lower-income older adults on Medicaid and Medicare, said on the JHUSON website.
According to the study, Medicare defines homebound status to determine patient eligibility to receive services under the skilled home healthcare benefit by factors such as the need for skilled services; because of illness or injury, the need for supportive devices, special transportation or assistance from another person to leave home; or having a condition for which leaving the home is medically contraindicated. “Our conceptual approach to defining homebound status focused on the individual’s ability to leave the home,” the authors wrote in the study. “A measure based on eligibility for Medicare services may not reflect the number of people who are, in fact, unable to leave the home. … Our findings can inform improvements in clinical and social services for these individuals.”
Read the abstract: