How do they manage? Disabled elderly persons in the community who are not receiving Medicaid long-term care services.
OBJECTIVE
To expand our understanding of how low-income functionally impaired elderly persons are able to remain in the community.


METHODS
In-person and telephone interviews with 25 elderly individuals who applied for but did not enroll in Connecticut's Home Care Program for Elders (CHCPE). All met the state's nursing home level-of-care criteria. STUDY, DESIGN: In-depth discussions with a small, purposefully selected sample of functionally impaired elderly persons in the community.


RESULTS
Many sample members with very high levels of impairment and multiple chronic health conditions remained in the community without CHCPE services because of Medicare home health services combined with extensive levels of informal care. Some sample members, particularly those with more limited informal care networks, did not receive the level of care that they needed. Virtually all were at high risk for medical complications, hospitalizations for acute illnesses, falls, and further loss of functioning. Further, in many cases, informal care networks were overextended, stressed and vulnerable to break down. All but a few of those we interviewed were not receiving services through the waiver program for financial reasons. Most met Medicaid's income criteria but had assets that exceeded Medicaid's $2,000 limit. Several were not participating due to concerns about estate recovery.


CONCLUSIONS
Additional formal help is needed to avoid eventual nursing home placement for many sample members. This could be achieved by expanding the availability of case management services and/or relaxing program financial requirements. Further, efforts to reduce Medicare home health expenditures must recognize the heightened vulnerability of many beneficiaries for potentially costly adverse outcomes.
O'Keeffe
J
J
Research Triangle Institute, USA.
Long
S K
SK
Liu
K
K
Kerr
M
M
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics; D003153:Community Health Services / Q000191:economics; D003237:Connecticut; D005260:Female; D016330:Frail Elderly / Q000523:psychology; D006297:Health Services Accessibility / Q000191:economics*; D006301:Health Services Needs and Demand; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008484:Medicaid; D011203:Poverty; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States