Can home care services achieve cost savings in long-term care for older people?
OBJECTIVE
To determine whether efficient allocation of home care services can produce net long-term care cost savings.


METHODS
Hazard function analysis and nonlinear mathematical programming.


RESULTS
Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself.


CONCLUSIONS
Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.
Center for Policy Research, Syracuse University, New York, USA. vgreene@maxwell.syr.edu
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D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D015276:Health Care Rationing / Q000191:economics; D006299:Health Services for the Aged / Q000191:economics*; D006699:Home Care Services / Q000191:economics*; D006707:Homes for the Aged / Q000191:economics; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D008432:Mathematical Computing; D009735:Nursing Homes / Q000191:economics; D016016:Proportional Hazards Models; D014481:United States