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Not Receiving Needed Help with Daily Activities May Increase Medicare Spending

The Issue

Older adults who need help moving around, taking care of themselves, or handling household responsibilities but do not receive such assistance have higher Medicare expenses than those with adequate assistance. This kind of help is not only critical to maintaining quality of life and health, it also may help curb health care spending by preventing situations — such as being socially isolated or not eating enough — that can lead to health problems and hospital visits.

Writing in the Annals of Internal Medicine, Commonwealth Fund–supported researchers reported findings from their study of whether community-dwelling older adults’ access to adequate support for daily activities affected annual Medicare spending.

What the Study Found

  • More than one of five study participants with mobility and self-care disabilities reported negative consequences from not having anyone available to help with activities that were difficult to perform by themselves.
  • More than 39 percent of participants with difficulty or needing help in toileting experienced an adverse consequence because of inadequate assistance. About one-quarter of participants with mobility issues reported not being able to go outside (27.9%) or move around their homes (22%) as a result of inadequate assistance. Among those who had trouble with keeping track of prescribed medication, 22 percent said they had made mistakes because of inadequate assistance.
  • Annual Medicare spending was more than twice as high among participants with disabilities as those without disabilities. The type of disability as well as the availability of adequate support influenced spending. Median per-person spending was higher for participants with self-care disabilities ($3,200) and mobility disabilities ($2,300) who experienced negative consequences from inadequate support compared to those who did not experience negative consequences.
  • Study findings suggest more than $4 billion in additional spending may have been incurred by Medicare in 2015 as a result of excess costs related to inadequate support among older adults with self-care or mobility disabilities.

The Big Picture

The study validates the importance of recent reforms to health care delivery and payment aimed at addressing patients’ nonmedical needs, including housing, transportation, and support for daily activities that are fundamental to health and well-being. Health care and community stakeholders should coordinate services and strategically identify individuals with high care needs who will benefit from programs that provide access to such services.

The Bottom Line

Medicare could offset billions in spending per year by investing in interventions aimed at addressing mobility and self-care limitations among community-living older adults.

Publication Details

Publication Date: June 6, 2019
Contact: Deborah Lorber, Director, Editorial Services, The Commonwealth Fund
Email: dl@cmwf.org
Summary Writer: Maggie Van Dyke
Citation:

Jennifer L. Wolff et al., “Medicare Spending and the Adequacy of Support with Daily Activities in Community-Living Older Adults with Disability,” Annals of Internal Medicine, published online May 28, 2019. https://doi.org/10.26099/etk0-xx03

Experts

Jennifer L. Wolff
Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
Lauren Hersch Nicholas
Assistant Professor, Department of Health Policy and Management and of Surgery, Johns Hopkins Bloomberg School of Public Health and School of Medicine
Amber Willink
Assistant Scientist, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
Research Data Analyst, Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health
Professor Emerita in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
Judith Kasper
Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health