Case scenario:
Focus on the methodology/design to answer how the research question posed in the case study illustrated below will be accomplished. Address why your approach was chosen versus another while addressing the following:
1) Participants (population, sample method, and sample size) - Include the strategy for acquiring participation in your study as well as ethical measures to secure the participant and their identity.
2) Instruments - Describe the instrument, what will be measured, and how the scores will be calculated.
3) Procedures - How will your instrument be delivered, what threats are there to reliable data, and the role of the researcher or participant.
Keep in mind, no data will be collected during this phase, but merely describe the how and what are your findings are. To complete the above part follow APA guidelines. Essentially, you will do everything up to, but not including the data collection. You may discuss articles in a variety of sources, both academic and commercial; however, with at least three academic (peer-reviewed) sources and I want to be a minimum of 3 to 4 pages.
Case study:
Background of the Problem:
The purpose of this study is to investigate the cost effectiveness of home health benefits for the elderly. Many aging adults fear having to living in a long term care facility or nursing home. Fear of abuse or neglect, loneliness, and rapid physical decline (Coach, 2006) are some of the reasons cited for fears associated with nursing homes. However, for some families, taking care of a loved one at home has become too difficult or time consuming. Adult children have jobs and financial responsibilities to their families. Sometimes a particular illness, like Parkinson’s or Alzheimer’s Disease makes it too much of a burden for one caregiver to handle on a regular basis.
Medicare benefits do not pay for nursing home care. Private insurance will pay, but usually if the policy holder has long term care coverage. There are many more people who become eligible for Medicaid. Adult children who feel responsible may experience feelings of guilt, it they are unable to provide full time care. However, most insurance and Medicare benefits do not pay for home health care.
It has been argued that, as many aging adults want to remain in their homes, the cost of providing home health care benefits would be far less than the cost of a skilled nursing facility, and would allow aging adults to alleviate the fears of declining health, with increased age. The daily national average for nursing home care is $200 per day, for a double room, $6,753 per month, and roughly $50,000 per year (Genworth, 2012).
Research Question:
Though most third party payersdo not pay for nursing home care, both Medicare and Medicaid pay for home health services. When third party payers don’t pay for complete home care, adult children or spouses pick up the slack and in some instances, may provide most of the care. Such caregivers may experience stress related health issues, which may result in more money spent on health care, particularly if health issues require hospitalization or ongoing treatment. The Illinois Homecare and Hospice Council (2010) claims the cost of providing care at home, similar to that in the nursing home, is $150 per day. This would result in a savings of $18, 250 annually, for home care rather than nursing home care.
Though home care may be less costly, there are other variables that may influence cost, such as transportation to a facility for diagnostic testing or procedures, potential costs for injuries due to accidental falls and other accidents, and costs associated with failing/forgetting to take necessary medication. Nursing homes and long term care facilities can take advantage of economies of scale, particularly when it comes to ordering supplies and establishing relationships with suppliers. This means Medicare or Medicaid will likelypay more for supplies sent to individual households, rather than to entire 100-bed facility, for example.
The research question of interest then is “are annual home healthcare benefits for the elderly more cost effective than benefits of long term institutional care?”
Hypotheses:
Given that A=home care benefits and B= nursing home(long term care benefits,
Research hypothesis HA : cost A < cost B
Null hypothesis H0 :Cost A>/ = cost B
Literature Review:
Currently, programs that pay for elderly care services pay less overall for home care services, than for care services in long term care facilities. “A recent study of Medicare claims data showed that when used as the first post-acute care setting for hip fracture patients, homecare saves the Medicare system $5,411 per patient” (Hoak, 2012). This figure is for a single incident of hip fracture. If cost savings are similar for other health issues, the potential for government healthcare programs aimed toserve the aging population, to reduce expenditures, is great. However, cost is only one aspect of cost-effectiveness. For services to be of value in maintaining or improving health, they must be effective. Home care services are only effective if they allow aging seniors to remain in their homesand to maintain relatively health. Stuck, et al., (1995) suggest that comprehensive geriatric involvement can allow seniors to maintain health, when visits are conducted by nurse practitioners. Such services, however, may be more costly than visits by registered nurses or home health aides. When measuring and comparing costs for care, the types of services received at home should be similar to those receivedin the long term care facility.
Many family members provide care for aging seniors when home health services are not available on when the limit on the number of daily hours has been met. What makes this difficult tomeasure, is the number of informal care givers providing care for aging seniors and the ability to assign a cost to this type of care. Chappell, et al. (2004) have conducted an investigation comparing home care and institutional care costs, which “reveal that home care is significantly less costly than residential care,even when informal caregiver time is valued at replacement wage.” This means the care provided by spouses, children, and other relatives or friends is given a monetary value in determining cost.
However, the care family members may provide can end up taking a toll on the physical and/oremotional health of the family member, particularly when most of the care is provided by one familymember and home health services provided by a professional service are limited. It becomes more difficult to place a monetary value on the costs to the family care giver. At the same time, the quality of care provided by the family care giver may be different from that provided by a professional homecare service organization.
Quality of life, for elderly living at home, can be compromised. While many fear their quality of life will be negatively affected in a nursing facility, it can be affected at home, by reduced mobility, decline in ability to provide self care, and decline in cognition. If professional and skilled health care providers are not available to promote the services required and do not take a proactive approach, those elderly who choose to remain at home many experience poor quality of life (Markle-Reid, et al., 2006). Though costs for home care may be lower, this does not necessarily translate into better or more effective care to maintain or improve quality of life at home.