Performance measures, hours of caregiving assistance, and risk of adverse care outcomes among older adult users of Medicaid home and community-based services.
OBJECTIVE
This study used validated physical performance measures to examine function, risk of adverse health outcomes, and the relationship with allocated hours of weekly caregiving assistance among older adults receiving home and community-based services through a Medicaid waiver program.


METHODS
Older adults (n = 42) completed physical performance measures including grip strength, 30-s chair rise, Timed Up and Go, and gait speed. Demographic information including age, gender, and allocated hours of weekly caregiving assistance were also collected.


RESULTS
A majority, 72% of females and 86% of males, had weak grip strength, 57% met criteria for fall risk based on their Timed Up and Go score, 83% had lower extremity strength impairments, and 98% were unable to ambulate more than 1.0 m/s. Frailty was prevalent in the sample with 72% of clients meeting Fried's frailty criteria. The most significant predictors of allocated hours of weekly caregiving assistance approved for clients were race and gait speed.


CONCLUSIONS
Based on scores on physical performance measures, clients are at risk of falls, hospitalization, and mortality, and scores indicate an urgent need to assess performance in addition to self-reported activities of daily living limitations for this population. Performance measures associated with quantifiable risk of adverse outcomes can be critical indicators for referrals and services needed to enhance the safety and improve care outcomes for homebound older adults.
Center for Research on Health and Aging, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA; Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, USA.
Margaret K
MK
Danilovich
Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, USA.
Daniel M
DM
Corcos
Center for Research on Health and Aging, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
David X
DX
Marquez
Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.
Amy R
AR
Eisenstein
Center for Research on Health and Aging, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
Susan L
SL
Hughes
Home and community-based services; frailty; older adults