In both studies, the intervention increased quality of life and functional outcomes, which were primary outcomes of the study by Stuck and colleagues. In this study, however, the rates of admission to acute care hospitals and short-stay nursing homes were not reduced. The cost calculations made in both studies are complex and, I believe, fail to make a convincing case that the interventions actually save money. The charge for a routine office visit to a primary care physician is usually less than a home visit by a nurse. The challenge in interpreting any study that deals with home visits is that many patients, caregivers, and policymakers have already decided that this is a good way to take care of the frail elderly and the disabled.
Elderly persons use many support services.
Key to the success of home care or outreach preventive services is the availability of programs that are acceptable to the patient and suited to the environment in which the patient lives. An important goal of any program is to reduce the use of health care services, which includes not only hospital and nursing home admissions but also home care visits. Most elderly persons want to be independent. To the extent that our services allow that to happen, the patient will have a valuable outcome. Future research that helps to determine the proper balance of services for each patient will be welcomed.