6.2 Will more LTSS also yield reductions in the use of medical care?

Ensuring that frail elders have food, shelter, hygiene, and meaningful human contact is certain to enhance their experience of life. Deficiencies in these basic needs are painful, discouraging, and the origin of many issues of ill health. The fear of these deficiencies often yields a crippling anxiety that drives out the possibility of joy and a good quality of life.

But is a frail elderly person who has adequate supports also less expensive? Studies of various interventions in circumstances of deprivation or scarcity indicate that this might well be the case. A study in California showed that poor adults were in the emergency room with hypoglycemia much more often in the last week of each month than in the rest, presumably because they ran out of their monthly allotment of public support for purchasing food (“food stamps”).[185] Decedents who had and used long-term care insurance to cover LTSS needs had only 2/3 of the hospitalization costs in their last year, compared with matched decedents who did not have long-term care insurance, and their medication and outpatient costs were lower.[186] One study estimated that every $25/year increase in funding for home-delivered meals per older adult was associated with a 1% decline in nursing home admissions.[187] In people with severe asthma, research establishes that improved housing has a profound effect upon the rates of emergency room use.[188],[189],[190] The Commonwealth Care Alliance in Massachusetts has a Senior Care Options program for frail elders relying mostly on capitation from Medicare and Medicaid and providing comprehensive services, and it reports cutting hospital days nearly in half and nursing home placements by 2/3.[191]

However, the research is sparse and uneven, and the overall impact probably depends upon how generous the supportive services become. With frail elders, the interaction of the timing of death with the deprivation creates a complicated methodological problem, since persons with such inadequate supports for everyday needs that they die earlier also become less costly. However, a community is likely to be highly motivated to avoid having hunger, exposure, and other seriously adverse human experiences affect anyone in the last years of life. That motivation will probably assure investments to provide these basics, and that might help reduce health care costs. Furthermore, a set of arrangements that yield confidence in care in old age at current costs helps relieve pressures on other social expenditures, such as schools and infrastructure.

[185] (Seligman, et al. 2014)

[186] (Holland, Evered and Center 2014)

[187] (Thomas and Mor, The Relationship between Older Americans Act Title III State Expenditures and Prevalence of Low-Care Nursing Home Residents 2013)

[188] (Karnick, et al. 2007)

[189] (O’Sullivan, et al. 2012)

[190] (Bhaumik, et al. 2013)

[191] (Meyer 2011)