Evaluation of a Long-Term Home Care Program

This article reports the outcomes of a 9-month evaluation of the Five Hospital Homebound Elderly Program (FHHEP), a model long-term, comprehensive, coordinated home care program in Chicago. Outcomes assessed include the mortality, comprehensive functional status, and rates of hospitalization and of institutionalization of the elderly (mean age, 80.4 years), chronically impaired population served by the FHHEP. The evaluation utilized a quasi-experimental, preposttest design with a nonequivalent control group consisting of similarly elderly and impaired subjects who received OAA Title III-c home-delivered meals. Consecutively accepted experimental (n = 122) and control group clients (n = 123) were interviewed using the Duke/OARS Multidimensional Functional Assessment Questionnaire at the time of acceptance to service and 9 months later. Service utilization data were also obtained for both groups to correlate client outcomes and characteristics with level and type of services used. Data collection took place over a 31-month period. Posttest functional status measures were obtained for 83% of experimental and 81% of control subjects. Multivariate analysis was used to control measured pretest differences. Major findings include a significant reduction in the nursing home admissions (16 vs. 28) and nursing home days (including sheltered care) of experimental group clients. The reported analyses also show an increase in experimental clients' sense of physical health well-being and a decrease in their number of previously unmet needs for community services. Somewhat paradoxically, the experimental sample also demonstrated a decrease in physicial activities of daily living (PADL) functioning. The mortality and hospitalization rate were equal for both groups. Despite savings in nursing home days of care, average per-capita costs for experimental group clients were 19% higher than for controls. However, this additional cost was accompanied by an increase in quality of life. Longer-range cost and outcomes are being assessed through a 4-year follow-up study currently in progress.