The message that home- and community-based care is more cost effective than institutional care has been touted by federal and local governments and those within the healthcare community, but a new comparative effectiveness review of long-term care of older adults receiving home- and community-based services versus care in institutions concludes that there is not enough evidence in the literature to determine cost effectiveness.
Researchers from the Agency for Healthcare Research and Quality (AHRQ) examined long-term care patient outcomes and costs based on a final tally of 42 articles addressing 32 different studies. The researchers pared down their eligible articles from 2,043 references.
"Determining whether and how the delivery of (long-term care) through (home- and community-based services) versus (nursing homes) affects outcome trajectories of older adults is difficult due to scant evidence and the methodological limitations of studies reviewed," the researchers wrote. "More and better research is needed to draw robust conclusions about how the setting of care delivery influences the outcomes and costs of (long-term care) for older adults."
Alan Rosenbloom, the president of the Alliance for Quality Nursing Home Care, an organization representing post-acute and long-term care organizations, agrees with the AHRQ's conclusion that there is just not enough research available to determine cost effectiveness and outcomes.
From a policymaker perspective, he said, it's important to find out if home- and community-based care services are saving any money because as the population ages, more services will be needed. "What is the most cost effective way to deliver the services people need?" he said. Figuring that out, he said, is "going to be important."
Rosenbloom suggested that this AHRQ review gives policymakers and others in the long-term care industry an opportunity to think about how the post-acute care system in the country functions and how care within that system is reimbursed.
"Should we be designing policies that not only address these home- and community-based services versus facility-based services issue for the chronic population – the long-stay population – but also investigating whether by making modifications to how Medicare pays for post-acute services, you could create a system where you're paying more based on the patient needs and less on the site of care?"
The AHRQ researchers concluded that given the weakness of the research available, "policy decisions will likely continue to be made on the basis of preferences and beliefs (largely the preferences and beliefs of policymakers but perhaps those of consumers, as well)."
Responding the AHRQ's research, a CMS spokesperson said, "We are working to give people with long-term care needs the choice about how and where to live their lives. No one should have to live in an institution or nursing home if they can live in their homes and communities with the right mix of affordable supports."