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Nearly 2 million Medicare enrollees homebound in US

Over 2 million individuals, aged 65 years and over, are homebound or mostly homebound in the U.S., exceeding the population of those in nursing homes, according to recently published data in JAMA Internal Medicine.

“The homebound population of older adults is 50 percent larger than the nursing home population in this country but almost completely invisible. Only 11% receive homebound medical care, and the others may receive no care or intermittent care,” study researcher Sarah Szanton, PhD, ANP, FAAN, Johns Hopkins School of Nursing, said in a press release.

To more accurately estimate the homebound population within the U.S., researchers developed measures of the frequency and ability to leave the house, and analyzed data from the 2011 National Health and Aging Trends Study. The term homebound was defined as never or rarely leaving the home within the last month. Semi-homebound was defined as only leaving the house with assistance, or having difficulty leaving the house.

Results demonstrated that 5.6% (95% CI; 5.1%-6.2%) or 395,422 participants were homebound and 1,578,984 participants were semi-homebound in 2011.

Among semi-homebound participants, 3.3% reported that they never left home without assistance, and 11.7% reported that they had difficulty or required help to leave the house.

Participants who older and of nonwhite race were more likely to be homebound (P < .001), as were women (P < .006). Completely homebound individuals also tended to have twice as many chronic conditions and were more likely to have been hospitalized in the last year (P < .001 for both), compared with non-homebound participants. Depression and dementia were significantly more likely among completely homebound participants (P < .001), compared with those who were not homebound.

The researchers noted that these results may help to identify patients who may benefit from programs geared toward homebound individuals.

“As Medicare considers home health payment reform and changes in the methods of paying for medical care, the development and dissemination of home-based primary care and associated quality frameworks are essential,” Szanton and colleagues wrote. – by Casey Hower

Disclosure: The researchers report no relevant financial disclosures.