More Adults Homebound Than In Nursing Homes

Katherine Ornstein, PhD MPH Assistant Professor Brookdale Department of Geriatrics and Palliative Medicine Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place, Box 1070 New York, NY 10029MedicalResearch.co Interview with:
Katherine Ornstein, PhD MPH
Assistant Professor
Brookdale Department of Geriatrics and Palliative Medicine
Institute for Translational Epidemiology
Icahn School of Medicine at Mount Sinai
New York, NY 10029

Medical Research: What is the background for this study? What are the main findings?

Dr. Ornstein: Although we are rapidly expanding services to support the medically complex homebound population there are no precise measures or estimates of the homebound population in the U.S.

We have provided the first national estimates of the homebound population in the U.S. Almost 6% of the community-dwelling Medicare population, or 2 million Americans, are homebound, meaning they rarely or never leave the home.  An  additional 15% of the population (6 million) may be at risk of becoming homebound because they only leave the home with another person, or have difficulty doing so alone.

What should clinicians and patients take away from your report?

Dr. Ornstein: 2 million older Americans are homebound. This estimate is larger than the current U.S. nursing home population. Our proposed definitions and national prevalence estimates may be helpful for developing and evaluating the effectiveness of initiatives and programs to care for the homebound, an area of particular importance given Medicare home health payment reform and an overall shift toward more value-based payments.

Currently, only 12 percent of those who are completely homebound report that they received primary medical care services at home.  How do the vast majority receive medical care? There is clearly a need to support the ongoing development and dissemination of home-based primary care.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Ornstein: We have created definitions of the homebound  to help determine eligibility for services and facilitate long-term estimates of this population for research and service development

Recognition of the vast number of individuals in the U.S. who are unable to get out of the home at all or without help has important societal implications in terms of future planning for this growing population, e.g., medical and home care, housing,  transportation needs. If we consider population growth estimates, the number of homebound individual will likely double in 50 years.

While homebound individuals have more chronic illness and disability, our work suggests that homebound status may also be due to social, psychological, and environmental phenomena.  There is a sizeable group of individuals who are not homebound because they have caregivers who help them to get out. Additionally, future work should examine the role of environmental factors in contributing to homebound status. For example, an individual may be homebound simply because they live in a “walk up apartment”

Citation:

MedicalResearch.co Interview with: Katherine Ornstein, PhD MPH, Assistant Professor, & Brookdale Department of Geriatrics and Palliative Medicine (2015). More Adults Homebound Than In Nursing Homes