The Elderly Should Benefit From Expanded Home Health Care but Increasing These Services Will Not Insure Cost Reductions

In response to a congressional request, GAO reviewed evaluations of projects offering a wide range of community-based health care services to determine the cost and effectiveness of expanded home health care service.

In examining nursing home use, GAO found that service availability did not conclusively reduce the use of nursing homes among the elderly and that more work is needed to better define and identify individuals for whom nursing home use can be reasonably decreased. Recent studies indicate that the effect of expanded home health care on hospital use is still unclear. GAO has found evidence that individuals who receive expanded home health care services live longer than others who use the currently available health services, and they report feeling more satisfied with their lives. However, the actual effect of home health care services on clients is not clear because of methodological problems in evaluations. GAO found that, while individual nursing home or hospital costs may have been reduced, total health care costs have increased. This is partly because a new population is being served that had not used similar health care services before and because of the costs of the expanded services, including administrative and monitoring costs. GAO found inconclusiveness and many conflicts in the findings of existing evaluations of home health care services which arose from methodological problems in research. However, new research efforts may avoid many of these problems because of their design. It appears that expanded home health care is not likely to reduce overall health care costs. However, other options may be available.