New York City Medicaid Beneficiaries Who Receive At-Home Care Not Receiving ‘Full Range’ of Services, Study Says

New York City Medicaid beneficiaries who are cared for in their homes "may not be receiving the full range of care services that they need," even though they have health needs similar to those of beneficiaries cared for in nursing homes, according to a new study from the United Hospital Fund. The study compared the level of long-term care provided in 1999 to New York City Medicaid beneficiaries through the Home Attendant program, which cared for 46,700 individuals in their homes, and through nursing homes, which cared for 39,700 individuals. For each program, the researchers examined beneficiaries' needs and conditions, amount of money Medicaid spent for personal care -- defined as assistance with daily living activities, such as bathing and eating -- and care provided by family members. Researchers looked at a sample of 283 Home Attendant recipients in New York City and obtained information about the care of nursing home patients from the New York State Department of Health. The study, published in February 2002, found that "substantial numbers of people with similar conditions and needs" were being cared for in both programs, but it is likely that beneficiaries under both programs were "receiving different levels of care." The report says that nursing home residents were "generally frailer and sicker" than individuals being cared for at home, but two-thirds of Home Attendant recipients also had "high levels of need," including clinically complex conditions, severe behavioral problems and cognitive impairment, and might not have received the "complement of services that are best suited to their needs." The report recommends that Home Attendant beneficiaries receive community-based services beyond the personal care services and quarterly nursing visits provided through the program.

Costs Involved
Average Medicaid spending on individuals cared for at home was "nearly always less than or equal to" spending for nursing home patients, the report notes, but the costs of care for individuals with "extensive needs" was "remarkably similar" between the two programs. Noting that public policy debates on long-term care often have been limited to comparing average spending on individuals in home care with those in nursing home settings, the report states that because the amounts are virtually similar, the debate should move on to how to expand community-based programs to meet more needs. Examining care provided by family members, the report says that New York's Medicaid program would spend nearly $10,000 more per Home Attendant recipient per year if not for the help of family care givers. In conclusion, the report recommends that the state test and expand community-based care services; better train, supervise and compensate home attendants; and ensure that family care givers are fully consulted, informed and assisted in providing care (Hokenstad et al., "Medicaid Long-Term Care in New York City: Comparing Needs and Personal Care Services in the Medicaid Home Attendant Program and in Nursing Homes," February 2002).