Homebound Seniors Have Increased Medical Woes, Health Costs

A recent article in U.S. News & World Report summarized the findings of a medical research study on older adults who are homebound. “2 Million Elderly Americans Were Homebound in 2011,” the June 3 article revealed.

Senior shut-ins were defined as “homebound” if they had not left the house in the past month and “mostly homebound” if they had rarely left the house in the same time period. Two million represents approximately 6% of the senior, community-based Medicare population, a figure significantly greater than the estimated 1.4 million nursing home residents.

Being able to age in place at home is a valued way in which to spend one’s senior years. Being homebound, however, is not. The study found that Americans who were completely homebound were more likely to have higher rates of disease and medical symptoms, as well as significant functional limitations and higher mortality rates.

In addition to chronic medical problems and disability, an older adult’s homebound status was also found to be influenced by psychological, environmental, and social factors. Completely homebound adults were likely to be female, non-white, less educated, and with lower incomes than their non-homebound counterparts.

Most significantly, researchers found that social supports could be as important as one’s physical condition in determining one’s status. Many individuals who otherwise would meet the profile for being homebound are more mobile due to the assistance of caregivers, including family, friends, neighbors, and paid aides. This finding certainly speaks to the positive effects of caregiving on older adults’ quality of life.

But for those who are completely homebound, the consequences can be difficult to overcome. In addition to social isolation, being homebound can have long-term medical effects. Only about 12% of homebound individuals in the study indicated that they received any primary care services in their homes.

A Healthline analysis of the study indicated that homebound individuals who do not receive medical services at home are often unable to travel to medical appointments. Such individuals become “invisible” until a medical catastrophe occurs, leading to a hospital stay.

In addition to the negative impact upon older individuals, homebound seniors in crisis place increased financial costs on an already overburdened Medicare system. This problem will only grow, as the population over the age of 65 will nearly double by the middle of this century.

In its Health Care Index, U.S. News & World Report tracks a variety of factors in health care, from medical costs to health industry employment. In its latest report, two themes emerged across all the sub-indices of the report: One is the increase in government-sponsored health care; i.e., Medicaid and Medicare, particularly as some states have expanded Medicaid. The other is the growing payment toward services for older adults as baby boomers age.

Bottom line: Services that reach into seniors’ home, from medical care to non-medical services, can provide benefits to older individuals and reduce the strain on more expensive emergency services and long-term care.

For additional information, the full research study results are available for review in the JAMA Internal Medicine Journal.