People who are homebound and have difficulty accessing office-based primary care are among the most costly patients in the U.S. health care system.
We recently used data from the National Health and Aging Trends Study (NHATS) to define various levels of “homeboundness” among community-dwelling Medicare beneficiaries age 65 and over, based on their frequency of going out of their home and whether they have difficulty, and/or require help to do so.
Almost 2 million older adults are completely or mostly homebound, and another 5.5 million are semi-homebound — i.e., they are dependent on others or have difficulty leaving the home. What we love about this slide is that it shows in a glance that, even among older adults who are able to get out of their homes, substantial proportions can’t easily get out of their homes and require help to do so. In fact, even among the vast majority of older adults who do leave the home on most days or every day, more than 400,000 never leave the home by themselves.
These data have substantial implications for payers, providers, and policymakers who, for the most part, are blind to the existence of this patient population. Recent results from the federal Independence at Home Demonstration program show that home-based primary care can reduce health costs by approximately $3,000 per Medicare beneficiary per year.