Health Care Utilization Among Homebound Elders

Abstract

Objectives To describe informal caregiver and patient characteristics associated with high caregiver burden in homebound elders and to examine associations between high caregiver burden and patient health care utilization at the practice level. Method We used a cross-sectional and prospective cohort design to study 214 caregiver-patient dyads in a home-based primary care program. Results Informal caregivers with the highest burden were more likely to help with more activities of daily living and instrumental activities of daily living and spend >40 hr/week in caregiving. Patients whose caregivers experienced the highest burden were more likely to be non-White males without 24-hr paid homecare. There were no significant independent associations between high burden and high calls, high visits, or social work involvement. Discussion In this medically complex and highly dependent population, further study of how families and other caregivers impact health care utilization is needed.

The Critical Role of Social Workers in Home-Based Primary Care

“…In addition, levels of burden among caregivers were high as compared to reported values from other populations such as elders with dementia. Burden was highest among caregivers who spent over 40 hours a week providing care and those who helped with a greater number of activities of daily living (Reckrey et al, 2013). …”

“…What started as a small pilot project in [XX] in 1995 has grown into the largest academic home based primary care program in the U.S. and currently cares for more than 1000 homebound individuals across [XX] each year. Patients in the program suffer from a wide variety of chronic illness and enter the program with significant symptom burden (Wajnberg, Ornstein, Zhang, Smith, & Soriano, 2013) as well as significant unmet biomedical and psychosocial needs (Katherine Ornstein, Smith, & Boal, 2009) and high levels of caregiver burden (Reckrey, Decherrie, Kelley, & Ornstein, 2013). In order to safely stay at home, these patients need significant support from the entire MSVD team including physicians, nurse practitioners, nurses, administrative support, and social workers.…”

Prevalence of and factors associated with homebound status among adults in urban and rural Spanish populations

“…Homebound status has been found to be associated with different variables that favour and perpetuate it, and with increases in health care costs and greater caregiver burden [ 1 , 8 , 9 ]. The main related variables are age, degree of cognitive impairment, dependence in basic and instrumental activities of daily living (ADL), depression, loss of visual acuity, obesity and low body weight, number of comorbidities, educational level, living in a multi-storey building with no lift, and not owning a car.…”

Burden on Caregivers of Adults with Multiple Chronic Conditions: Intersectionality of Age, Gender, Education level, Employment Status, and Impact on Social Life

“…There is strong evidence that gender plays a significant role in the experience of burden (Papastavrou, Kalokerinou, Papacostas, Tsangari, & Sourtzi, 2007;Reckrey, Decherrie, Kelley, & Ornstein, 2013). Across different populations, female caregivers usually report greater burden than their male counterparts, which is suggested to be a result of social pressure (Chappell, Dujela, & Smith, 2015;Papastavrou et al, 2007).…”

“…Therefore, those who feel stressed by the lack of financial security are expected to experience greater stress in fulfilling their roles as caregivers. Some of the other predictors of caregiver burden are employment (Akkus, 2011;Choi-Kwon, Kim, Kwon, & Kim, 2005); education level (Papastavrou et al, 2007), and ethnicity and availability of support (Reckrey et al, 2013).…”