Although the technical challenges are daunting, Brant Fries and his research group are working to compare outcomes in individuals who receive care in nursing homes versus those who receive care at home. “
It’s now possible to compare the care received in nursing homes against that received at home.
You can’t do a randomized control trial,” Fries points out. But thanks to a system for common measures that Fries and his group have developed, it’s now possible to compare the care received in nursing homes against that received at home.
“We found that when we can compare, home care seems to be better,” he says, adding that the research is both highly nuanced and highly controversial. He and his team are working to refine their methodology and test it in a variety of states. Given the growing desire of people to receive care at home rather than in nursing homes, the research is critical. “It sets up the question, ‘What is the right setting for people?’” Fries says. “What kind of care do they need? How do we identify the risks for individuals so that these risks can be better addressed?” As health professionals across the country start to move toward more integrated systems, these questions become even more significant.
Nursing Homes: Cost of Care and Planning for Care
Every nursing home in the U.S. uses a case-mix system developed by SPH Professor Brant Fries and his research team to establish payments rates to cover the cost of care for individuals on Medicare. Additionally, more than half of the 50 states use the same system for people on Medicaid. The novel case-mix system adjusts the rates that facilities are paid according to the complexity and difficulty of caring for individuals. As Fries explains, “If you’re providing care for a person who requires a great deal of care, you ought to get more money. People whose needs are not so burdensome should cost less.” It’s all about distributing resources logically and equitably, he says.
With an eye toward lowering costs, Fries and his team are also working with state governments to determine who, exactly, should receive long-term care, and what kind of care they’re currently receiving. His team found out that the state of Louisiana, for example, had three home-care programs with different eligibility criteria and vastly different reimbursement rates for each. As a result of their work, the state has been able to consolidate programs and reduce its expenditures. Abroad, policymakers in Finland are using the same methodology to develop a cost-effective long-term care system for the entire country.