Medicaid home care services and survival in New York City.
OBJECTIVE
New York City's Medicaid Home Care Services Program provides an integrated program of housekeeping and personal assistance care along with regular nursing assessments. We sought to determine if this program of supportive care offers a survival benefit to older adults.


METHODS
Administrative data from New York City's Medicaid Home Care Services Program were merged with epidemiologic and diagnostic data collected in a community study of older adults living in northern Manhattan. Of 866 older adults with Medicaid coverage living in the community, 288 (33.3%) received Medicaid home care services in the period from 1994 to 1996. Mortality was tracked through the end of 1999.


RESULTS
In proportional hazards models that adjusted for differences in sociodemographic, medical, and functional status, use of Medicaid home care service was associated with a significantly reduced risk of death in people with disability in activities of daily living.


CONCLUSIONS
Because the program has distinctive features (greater number of weekly hours than other programs, integration with nursing assessments), it is a special case of community-based long-term care. Still, results from this observational cohort suggest that mortality risk in the most vulnerable elderly population can be reduced through a program of supportive care.
Albert
Steven M
SM
Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA. sma10@columbia.edu
Simone
Bridget
B
Brassard
Andrea
A
Stern
Yaakov
Y
Mayeux
Richard
R
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D006299:Health Services for the Aged; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology; D016019:Survival Analysis