Jennifer M. Reckrey, M.D.

Older homebound adults who reside in assisted living communities and in metropolitan areas are the most likely to use home-based medical care, presenting an opportunity to expand care services to a vulnerable population in need, say investigators.

Armed with data from a nationwide Medicare claims study, the researchers assessed the sociodemographic, geographic, and clinical characteristics tied to receipt of home-based medical care. Aside from their living situations, care recipients who were homebound also were more likely to have a dementia diagnosis, have been hospitalized within the past 12 months, to die within 12 months of the study interview, and to receive Medicare home healthcare.

“The significant unmet needs of this high-need, high-cost population and the known health and cost benefits of home-based medical care should spur stakeholders to expand the availability of this care,” lead author Jennifer M. Reckrey, M.D., said.

But additional findings reveal that the number of people who may benefit from this care is much greater than the number who receive it, Reckrey and colleagues wrote. Despite the apparent opportunity for expansion and shared savings for providers, they found no sustained growth in the proportion of Medicare beneficiaries receiving home-based medical care from 2011 to 2017. Only about 11% of those who were homebound and 5% of all beneficiaries studied received home-based medical services during that period.

The results suggest that “the current system of community-based primary care does not adequately meet the needs of medically and socially complex homebound people,” the authors concluded.