Medicare could reduce spending with better care coordination for seniors who are too healthy for nursing homes but too frail to live without some support, researchers write in the journal Health Affairs.
Roughly half of seniors in assisted living or other supportive housing have costly chronic diseases, while at least one in five need help with eating, getting from bed to a chair or using the bathroom, the study found.
Yet residential care settings often lack the information technology or care coordination that might prevent hospital or skilled nursing home admissions, wrote researchers from Harvard University and Vanderbilt University. About 17% of residential care housing had electronic health records for purposes other than billing and even fewer had records that could transfer critical data to hospitals (5%) or doctors (7%).
Meanwhile, seniors who lived in residential care and those in nursing homes were equally likely (23%) to land in the hospital in 2010, the analysis found. (Nursing home residents were more likely to make a trip to skilled nursing facilities.)
“These results suggest that the residential care facility population could benefit greatly from models that coordinate health and long-term care services,” write authors David Grabowski, Daryl Caudry and Katie Dean of Harvard and David Stevenson of Vanderbilt.
Most recent efforts to boost care coordination outside of hospitals has focused on patients at home or in institutions like skilled nursing facilities, but "there is obviously a really important setting between those," Grabowski said. Residents in those in-between settings have significant medical needs, but the sector has not adopted the innovation found elsewhere to better coordinate care. "There's much potential given the chronic illness, given the complexity, given the healthcare utilization" among those in assisted living, he said.
Seniors who lived in the community were healthier, less likely to need help with daily activities and less likely to need skilled nursing care. But they were also the most likely to be hospitalized.
With more investment, assisted-living facilities that already help residents with medication and provide physical and occupational therapy could introduce more clinical services, the authors said.
But the incentives to invest in such services and the IT infrastructure to support them are limited. There's no financial return for preventing hospital visits, and the facilities would face additional regulations.
New payment models that encourage lower-cost care could create new incentives for providers to bolster care coordination in residential care. “With an increased clinical presence, residential care facilities could be a possible substitute for skilled nursing facilities in certain cases,” the authors wrote.
Medicare managed care plans have had some success achieving savings with residential care, they add, citing Erickson Living, a company that offers a Medicare Advantage plan, assisted living, skilled nursing and other senior housing in 10 states.
