Effects and Costs of Day Care and Homemaker Services for the Chronically Ill: A Randomized Experiment

摘要

The study was designed to examine the effects of adult day care and homemaker services on a Medicare-eligible population and to assess the impacts of those services on institutionalization, outcomes, and Medicare costs. Patients were identified for whom the new services might prove more effective than existing options. Difficulty in enrolling patients in the program and low utilization rates for some groups of patients may suggest low demand for these services. The study also suggests that for the majority of patients, day care and homemaker services probably served as additional benefits under Medicare rather than substitutes for nursing home care. Net total Medicare costs (the new services plus existing Medicare services) were 71 percent higher for the day care experimental group and 60 percent higher for the homemaker experimental group. Experimental control group differences in physical functioning, psychosocial measures, and death rates are also presented.