Improved Knowledge Base Would Be Helpful in Reaching Policy Decisions on Providing Long-Term, In-Home Services for the Elderly

GAO reviewed the provision for in-home health or health-related services under four Federal programs, titles XVIII, XIX, and XX of the Social Security Act and title III of the Older Americans Act, to determine how well the services meet the elderly's need for long-term, in-home care. Each of these programs, administered by the Department of Health and Human Services (HHS), presents different requirements on the availability and use of in-home services.

GAO studies have shown that between 10 and 22 percent of the persons 65 years of age and older are not receiving all the homemaker/chore and personal care services they need. For the elderly who have their needs met, 76 percent of the cost of these services is provided by family and friends. The four Federal programs offer personal care and homemaker/chore services in the home, even though in-home services are not their primary mandate. Each program has different funding restrictions and eligibility criteria. Liberalizing the in-home services eligibility requirements would make in-home services available to more elderly persons and increase the cost of the programs. Various studies agree that in-home services prolong life and maintain or increase the elderly's independence. However, they disagree on whether providing long-term, in-home assistance affects the number of elderly who are or would be receiving long-term care in nursing homes. It has been recommended that a separate title of the Social Security Act be created to provide services other than acute medical and hospital care to needy persons who require long-term care. In making policy decisions, it would be helpful to know the extent of the existing network of service providers that are serving the elderly and why approximately 10 to 22 percent of the elderly are not receiving services from this network. It would also be helpful to know the cost of providing long-term, in-home services to the elderly and what effects a Federal subsidy of such services would have on the existing network that is serving the elderly.