New Study Points to In-Home Care Benefits — Including Lower Costs

Aging and illness can be scary processes no matter how you slice it — but the opportunity to spend your sick days, or even your final ones, in the comfort of your own home can be a balm.

According to a pilot study by researchers at Boston’s Brigham and Women’s Hospital, the benefits of in-home care go far beyond emotional comfort. In the study of 20 patients — nine of whom received hospital-level care in their own homes, while the remaining 11 were admitted to traditional inpatient care — home patients were more physically active, got more sleep and had fewer laboratory orders.

Perhaps most surprisingly of all, the study found that in-home care cost significantly less than inpatient care: "Median direct cost for the acute care plus 30-day post-discharge period for home patients was 67% lower," the study reads. Plus, home patients experienced fewer readmissions, further lowering costs.

Benefits of in-home health care

The randomized trial took place between Sept. 12 and Nov. 13, 2016. The patients who were recruited for the study had presented with diagnoses of infection or exacerbation of heart failure, COPD or asthma, and were able to meet qualifying criteria such as home location, peripheral intravenous access and independent toileting ability. (Patients who required regular intravenous narcotics, had a positive domestic violence screening or an acute concomitant condition or were at high risk for clinical deterioration were deemed ineligible for the study.)

Each patient received at least one daily visit from an attending doctor and two daily visits from a registered nurse, with additional visits available 24 hours a day if needed. Home-care patients were set up with hospital-level care facilities, including oxygen therapy, respiratory therapies, intravenous medications, in-home radiology and point-of-care blood diagnostics, along with machine algorithm monitoring.

The primary finding of the study was that direct costs were substantially lower for home-care patients than for those admitted for inpatient care — by 52% for the acute care episode, and 67% when expanded out to include 30 days of post-acute care treatment. (The calculations did not include physician labor, which is usually calculated separately from other hospital costs anyway.)

Secondarily, the study found that patients who received in-home care also received care of a quality and safety level similar to traditional hospitalization. No adverse safety effects or hospital transfers occurred for the home-care patients, while one hospitalized control patient experienced an acute kidney injury.

Home patients spent, on average, more time being physically active than their hospitalized counterparts — a median of 209 minutes versus 79 minutes, respectively — and also spent more time upright. They also trended towards more sleep than hospitalized patients, and experienced fewer hospital-acquired disabilities.

In short, home-care patients seemed to fare better than those admitted for inpatient hospital care. Still, both groups reported high levels of patient satisfaction with their experience and would recommend it to others.

Is in-home health care accessible in 2024?

A 2022 study found that in 2017, 31% of Americans died at home. Although that’s still a minority, the figure made home "the most common site of death for the first time in decades." Still, many patients experience the end of their lives, and the intensive health care requirements leading up to it, in hospital or hospice settings — not to mention patients who recover from their illnesses to go on and lead healthy lives.

Although the Brigham’s and Women study is a small one — and the first randomized, controlled clinical trial of its kind in the U.S. — the success of the in-home model in this research begs the question: Is in-home care the future of illness and aging? And, more importantly, will insurers make it accessible to the average American consumer?

Despite the fact that in-home care may carry lower direct costs (at least per this study), some insurers still may not cover it in full — or have restrictions on the types of home care that are covered. For example, while most insurance plans offer some level of home health care services for acute need, long-term home health care coverage may vary.

However, there is some good news: Original Medicare covers the full cost of home health care for those enrolled in both Part A and Part B, though Medicare Advantage plans may not carry coverage for these services. (Medicare does not, however, cover long-term nursing home stays or pay for you to stay in an assisted living facility.)

For those who aren’t otherwise covered by their primary medical insurance, long-term care insurance may help with access to both medical and nonmedical in-home services. And, of course, shopping around for the best health insurance plan available — i.e., one that includes home-care coverage — is an essential step, especially for seniors who may need this care sooner than later.