• Benjamin H Oseroff, Claire K Ankuda, Evan Bollens-Lund, Melissa M Garrido, and Katherine A Ornstein.
• Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA. benjamin.oseroff@icahn.mssm.edu.
• J Gen Intern Med. 2023 Mar 1; 38 (4): 100110071001-1007.

BackgroundHomebound older adults have complex social, medical, and financial needs, but little is known about their healthcare utilization and spending.ObjectiveTo characterize healthcare utilization and spending among homebound older adults.DesignCohort study using National Health and Aging Trends Study data linked to Medicare Fee-for-Service (FFS) claims data.ParticipantsAdults aged 70 years and older with Medicare FFS coverage (n = 6468).Main MeasuresIn a person-year analysis, survey-weighted rates and adjusted marginal differences in inpatient, outpatient, and emergency department utilization and spending 12 months post-interview were calculated by homebound status, defined as reporting never or rarely (no more than 1 day/week) leaving home in the last month.Key ResultsCompared to the non-homebound, homebound observations had lower annual unadjusted rates of accessing primary care (60.9% vs 71.9%, p < 0.001) and specialist care (61.0% vs 74.9%, p < 0.001) and higher annual rates of emergency department use (54.0% vs 32.6%, p < 0.001) and hospitalization (39.8% vs 19.8%, p < 0.001). Total annual Medicare spending was $11,346 higher among the homebound compared to the non-homebound (p < 0.001). In a single year analysis (2015), homebound older adults accounted for 11.0% of Medicare spending among those over 70 despite making up only 5.7% of this population. 13.6% of the homebound were in the 95th percentile or above of Medicare spending in 2015. In models adjusting for demographic, clinical, and geographic characteristics, homebound status was associated with a decreased likelihood of having an annual primary care or specialist visit and $2226 additional total annual Medicare spending.ConclusionsHomebound older adults use more hospital-based care and less outpatient care than the non-homebound, contributing to higher levels of overall Medicare spending.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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