Title: Evaluation of a Comprehensive, Long Term Home Care Program for Chronically Impaired Elderly
Description: This dissertation reports the findings of an evaluation of the Five Hospital Homebound Elderly Program in Chicago. The Program is a model long term home care demonstration project which is community-based and provides a unique combination of medical and social supportive services to chronically impaired homebound elderly. The Program differs from most Medicare certified and reimbursed programs and is a potential model for expanded benefit programs now being considered in Congress. The evaluation of the Program encompassed both impact and process issues, utilizing a pre/post test quasi-experimental design with a non-equivalent control group. Within this design, the comprehensive functional status of 122 consecutively admitted Five Hospital clients and of 123 controls was assessed at time of acceptance to service and nine months later, using the Duke/OARS Multidimensional Functional Assessment Questionnaire. The control group consisted of recipients of OAA Title III home-delivered meals who live in an area that is geographically contiguous to the Five Hospital Program's catchment area and who were similarly elderly and impaired.

Rates of hospitalization, institutionalization and mortality were also obtained in addition to rates of home care services utilization for both groups. Analysis of pretest data, which was obtained on 75% of newly accepted FHHEP clients and 74% of control group clients, revealed that, overall, the two groups were remarkably similar on measured variables with the exception of. the fact that Five Hospital clients were significantly older (x̄ age 80.4) and more impaired in Instrumental Activities of Daily Living than controls but also enjoyed better social supports. These differences were of interest because advanced age, poor ADL and poor social supports are variables which have been reported to be associated with admission to long term care institutions in the literature. At post test, functional status data were obtained on 83% of experimentals and 81% of controls, with mortality being the major cause of attrition in both groups (12% and 11%, respectively). Major findings derived from the analysis of outcome measures revealed no difference between the two groups with respect to mortality rates.

However, bivariate analysis revealed interesting differences between the two groups with respect to the characteristics of subjects who died. Variables which appeared to be similarly and differentially associated with increased incidence of mortality in the two groups were therefore identified and discussed. However, the number of subjects who experienced this outcome in both groups was too small to permit any conclusions to be drawn. The fact that mortality rates were almost identical for the two groups, given the greater age and ADL impairment of experimental subjects at pretest, is interpreted as suggestive of a possible beneficial effect of treatment which might warrant follow-up in a study with a larger sample size. Effects of treatment on functional status included a trend towards perception of improved social supports. mental health and physical health, as well as a significant decrease in unmet needs among experimental subjects (p < .05). Somewhat paradoxically, these beneficial changes were accompanied by a significant (p < .01) deterioration in Physical Activities of Daily Living.

It is suggested that this change in PADL status may be confounded with the reception of the treatment which consisted of regular assistance with ADL tasks. Comparison of pre and post test hospitalization rates revealed no differences between the two groups, with the exception of the fact that fewer Five Hospital subjects were repeat users at pre and post test. A highly significant difference was observed in the rates of institutionalization for the two groups with experimental subjects experiencing this outcome less frequently than controls (p < .01). Multivariate analysis which attempted to control for selection differences and other explanatory variables failed to degrade this effect which remained significant. Furthermore. when the above outcome measures were analyzed according to level of treatment received, the same relationships described above were observed. The above findings were interpreted to indicate that, overall, the Program had beneficial effects on its clientele and that this model of long term care services has important implications for the development of national long term care policy.