Safer, cheaper and healthier: it's time to look again at home care for older people
The COVID-19 pandemic has exposed the strengths and weaknesses of global healthcare systems. One area it has shone a light on is home care, both its benefits and its challenges. The industry delivers services such as doctor visits, nursing services such as wound care and naso-gastric tube change, chronic disease management, bathing, physiotherapy services, and non-clinical services as medication reminders, bathing and companionship. The pandemic has up-ended institutional healthcare by limiting access to healthcare institutions as hospitals struggle to accommodate COVID-19 cases. Elective surgeries have been placed on hold, therapies have been interrupted and consultations curtailed. At the same time, the pandemic has exposed the vulnerability of nursing homes and skilled nursing facilities, which have seen rapid spread of the virus and have borne the brunt of COVID-19 deaths. In the US, 40% of deaths from this disease have been in nursing homes, while in Europe, 50% of deaths occurred in such facilities. In Canada, the figure has been as high as 80%. Staying at home has been the safest way for seniors to protect themselves during this pandemic, and to receive their needed medical services.
Why home care?
Even before the pandemic, home care has been a preferred care model for seniors. As people age, their biggest fear is loss of independence. In a 2007 study in the US, 26% of seniors said that their top fear was loss of independence. This was followed by 13% who identified moving out of the home and into nursing homes as their top fear. Death was the top concern of only 3% of respondents. The same survey showed that 89% of seniors believed it was very important to continue living at home. Such feelings are understandable. Living at home ensures that seniors can continue to make decisions about their daily lives and are plugged into their social networks. Care is more easily personalized, and seniors enjoy a higher quality of life and greater personal happiness. Home care has shown to be cheaper than institutional care, with improved patient outcomes.
A 2019 research study that examined 17 million Medicare hospital admissions between 2010 and 2016, comparing home care and admission to a skilled nursing facility, found that home care was associated with average savings of $4,514 in the 60 days after hospitalization. With the use of technology aids such as personal emergency response systems and tele-monitoring, costs decrease further, as patient outcomes improve. In a 2016 study of the home health industry, home care providers were asked about the impact of the use of telehealth. The largest impact with telehealth reported by respondents was a 75% increase in overall quality of care, an 63% increase in patient satisfaction, and 63% lower unplanned hospitalizations.