Beyond the GAO Cleveland study: client selection for home care services

Area of Science:

• Gerontology
• Health Services Research
• Public Policy

Background:

• Home care services are crucial for client well-being and resource allocation.
• The General Accounting Office (GAO) conducted a study on home care in Cleveland to guide client selection.
• Accurate cost and risk assessments are vital for effective home care program management.

Purpose of the Study:

• To critique the methodology and findings of the GAO study on home care client selection.
• To evaluate the GAO's "break even" analysis and risk of institutionalization model.
• To propose a more systematic framework for considering client selection in home care.

Main Methods:

• Detailed methodological review of the GAO study's cost-benefit and risk analyses.
• Conceptual framework development for systematic client selection.
• Analysis of an institutionalization model incorporating various client factors.

Main Results:

• The GAO study exhibits serious methodological flaws, undermining its cost and risk estimates.
• Targeting the highest-risk individuals, as recommended by GAO, may be an inefficient use of home care resources.
• Client selection should consider factors beyond institutionalization risk, including private support and political attractiveness.

Conclusions:

• The GAO study's methodology is flawed, questioning its conclusions on relative service costs and institutionalization risks.
• A revised approach to client selection for home care is necessary, integrating multiple relevant factors.
• More systematic and comprehensive criteria are needed for efficient and effective home care resource allocation.