Providing household help for frail elderly could avert hospitalizations and save money on nursing home care.

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Older people who do not have help for daily tasks such as dressing and bathing are much more likely to be hospitalized for acute illness than older adults who receive the help they need, a Purdue University study indicates, suggesting that reducing health care costs for older adults may be as simple as providing them with a little household help each day.

A research team, including Purdue nursing professor Laura P. Sands, found evidence that older adults who qualify for nursing home care because of their disabilities in daily tasks can continue to live in their homes provided they receive assistance with fundamental needs such as bathing, dressing and preparing food. Elders who lived alone without such needed assistance were more likely to require hospitalization. After a few weeks of help with daily tasks, however, the need for health care dropped off, implying that a little help win the basics goes a long way.

The report appears in the Feb. 6 issue of the Journal of the American Geriatrics Society. To examine what effect living with unmet needs had on the use of medical services, Sands' team studied 2,943 frail older people enrolled at 13 sites nationwide in the Program of All-Inclusive Care for the Elderly. The program provides medical and social services that also meets the daily living needs of those eligible for nursing homes.

The team discovered that those who lived with unmet daily living needs before enrollment in the program were more likely to live alone and to have been admitted to a hospital or nursing home in the previous six months. "People who have difficulty with bathing, dressing and walking across a room require our health care system to a greater extent," Sands says. "Those who have trouble performing such activities, have higher rates of hospitalizations, longer hospital stays, and more physician visits than those with no disabilities."

But after six weeks of receiving the program's services, the number of hospital admissions for those who had been living with unmet needs significantly declined, becoming similar to the admission rates of those who had their needs met before enrollment.

"What this suggests is that if a homemaker or personal assistant helps these frail elders for a few hours a day, they would be less likely to experience medical conditions such as hunger, dehydration, falls and skin problems that occur when disabled older adults do not receive needed help with daily tasks," Sands says. "As our government is under increasing pressure to develop fiscally feasible solutions for caring for disabled older people, we feel providing disabled elders with adequate home-based care should receive further attention."

Sands notes that $132 billion is spent yearly in the United States on long-term medical care, about 73 percent of which goes to nursing homes. Half of long-term care is paid by the government. Keeping a person in a nursing home costs the government around $30,000 per year, while paying a personal assistant to visit for a few hours a day would cost perhaps a third as much, she says. "More importantly," Sands says, "you'd be helping a person stay in their own home."

This research was funded in part by the National Institutes of Health.

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Compiled by Dennis Roszak