Summary: In home health care, as defined under Medicare, patients are given health services by nurses or therapists and personal care services by aides in their homes. Legislation has been proposed to expand the coverage of home health services, to encourage the establishment of home health programs, and to encourage families to provide care for elderly dependents in the home. GAO examined the likely effects of expanding home health care services focusing on: what effect home care services have on patient outcomes; the number of hospital and nursing home admissions; the length of hospital stay and patient discharge; and what circumstances might allow home health care to be a cost effective substitute for institutionalization. Demonstration projects and other research have found that expanded community-based services, including home health care, attain positive patient outcomes. Older Americans who receive expanded services in their homes may live longer. Cost studies suggest that home health care can be cost effective for some groups of people or for some services. However, the total cost of an expanded system of home care services is unclear and conclusive cost effectiveness results for the total population serviced may not be obtainable. Methods should be developed to assure early identification of patients before they enter institutions who could and would prefer to receive treatment in their own homes if appropriate services were available; incentives should be created so that patients actually move from institutional settings to alternative care settings; mechanisms are needed to insure that services provided at home are appropriate to the patient's needs; and the adequacy of current reimbursement mechanisms for home health care should be reviewed. Some of the current information gaps can be filled by examining appropriate placement, determining what patient or illness characteristics are most economically and effectively dealt with in each chronic care setting, developing methods for early identification of patients who can avoid institutionalization, developing mechanisms to insure that services are provided to patients who are most in need and that the services provided actually match those needs, and determining through demonstration programs if improved reimbursement mechanisms can be developed.
