How increasing personal care service might delay or prevent nursing home placement

Abstract

Aims: There is a pressing need to retain dually eligible elderly Medicare and Medicaid beneficiaries in the community. The objective of this study was to examine median personal care services (PCS) hours, and how increasing PCS to the median (for those below), might delay nursing home placement (NHP) and save cost. Methods: Retrospective study of PCS hours, costs, and NHP in a statewide home and community based waiver program in the Midwest serving 6525 dually eligible Medicare-Medicaid beneficiaries aged 65 and older. Two Minimum Data Set-Home Care assessments and Medicaid claim files were examined to identify PCS hours and cost. A model was developed to estimate costs of increasing PCS to the median to compare retaining at home compared to NHP. Results: Participants with PCS greater than the median hours had a NHP rate of 25%, compared to 36% for those with less than median PCS hours. To Sandra L. Spoelstra1, Charles W. Given2, Tracy DeKoekkoek3, Monica Schueller4 Affiliations: 1PhD, RN Michigan State University College of Nursing 1355 Bogue Street, Room C342, East Lansing, MI, USA; 2PhD, Michigan State University Institute for Health Policy instead of Department of Family Medicine, B106 Clinical Center, East Lansing, MI, USA; 3RN, Michigan State University College of Nursing 1355 Bogue Street, Room C340L, East Lansing, MI, USA; 4BA, Michigan State University College of Nursing 1355 Bogue Street, Room C340N, East Lansing, MI, USA. Corresponding Author: Sandra Lee Spoelstra, Michigan State University College of Nursing instead of College of Human Medicine, 1355 Bogue Street, Room C342, East Lansing, MI 48824, USA; Ph: (517) 353-8681; E-mail: spoelst5@msu.edu Received: 14 October 2014 Accepted: 10 November 2014 Published: 13 December 2014 attain a 25% NHP rate of participants below the median, we estimated savings by subtracting the usual monthly cost of the waiver ($960) from the monthly NHP cost and adding the cost of the additional PCS ($15.67/hour). For this sample, a total of $155,088 per month could be saved by adding PCS hours to the median. Conclusion: The NHP rate could be reduced from 25–36%, and savings of nearly $2 million a year could be realized by increasing PCS hours to the median and retaining participants in the waiver program. Evaluating waiver participants who are below the median number and increasing those who need it could help retain participants in the home setting, where they most want to be, and allow for tremendous cost savings.