Yale Bulletin and Calendar

May 3, 2002

Volume 30, Number 28

Restorative home care helps
elderly regain independence

Restorative home care for elderly patients ,rather than traditional home care enhances the patients' ability to remain at home, according to a study by a Yale researcher published April 24 in the Journal of the American Medical Association.

Unlike traditional home care, which focuses on treating individual diseases, restorative home care centers on improving or preserving patients' mobility and ability to live independently.

"These findings are important because a large number of older people receive home care services and they tend to have a large burden of illness and are at risk for functional decline," says Dr. Mary Tinetti, professor of medicine at the School of Medicine and lead author of the study. "This restorative approach to care appears to be both effective in maintaining or improving function and symptoms, in reducing the number of home care and emergency visits, and potentially saving costs."

Optimizing patient function and comfort, particularly for older, chronically ill persons with multiple illnesses, is particularly important following episodes of acute illness and hospitalizations, Tinetti says.

"Between 25% and 50% of all hospitalized older persons experience loss of function or functional independence during hospitalization," she says in the study. "According to previous studies, only a third recover to pre-hospital levels of functioning by three months."

The federal Center for Medicare and Medicaid Services recently mandated that attention be paid to functional outcomes of patients receiving home care as well as to reducing overall costs.

"The confluence of these mandates to both constrain costs yet improve outcomes provides the opportunity to investigate innovative and cost effective clinical strategies," Tinetti says.

The study compared the outcomes of 691 patients who received restorative care vs. a similar number of patients who received usual home care. The patients were 65 years of age or older, received at least seven days of home care, had no severe cognitive impairments, and were not terminally ill, bedridden, or requiring total care. The care was delivered by one of the largest home care agencies in Connecticut. The following areas were evaluated: functional status, likelihood of remaining home, duration and intensity of the home care episode, emergency visits to a physician, emergency department visits, and pain or shortness of breath.

Patients who were provided home care under the restorative care model had a greater likelihood of remaining at home (82% vs. 71%), a reduced likelihood of visiting an emergency department (10% vs. 20%), and also had better mean scores in self-care and mobility.

The restorative care model was based on principles adapted from geriatric medicine, nursing, rehabilitation and goal attainment. Among key characteristics are training of nurses, therapists and home health aides in rehabilitation, geriatric medicine and goal attainment; a team approach to maximize function and comfort, and input from the patient, family and home care staff in the process of establishing and reaching these goals.

Coauthors of the study included Dorothy Baker, William Gallo, Dr. Aman Nanda, Peter Charpentier and John O'Leary.

-- By Jacqueline Weaver

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