Long-term care facilities could see fewer new residents, but states could save money by expanding meal-delivery programs that enable some seniors to stay in their homes longer or avoid moving altogether, according to a new study by Brown University investigators.
The public health researchers analyzed state, Medicaid and nursing home data to project that if each of the contiguous states expanded by one percent the percentage of senior citizens receiving delivered meals, then 1,722 more Medicaid recipients would avoid living in a long-term care facility. Twenty-six states would realize a net annual savings from expanding their programs, whereas 22 would end up spending more. In every state, however, more "low-needs" seniors would be able to remain in their homes regardless of whether their care is paid for by Medicaid.
Across the country, the one percent expansion would bring meals to 392,594 more seniors at a cost of more than $117 million, the researchers say. Because 1,722 seniors would no longer need to live in nursing homes on Medicaid, total Medicaid savings would total $109 million, they add. The additional food delivery costs outstrip Medicaid savings nationwide, even though most states would save money on a net basis, because in some very large states with relatively few low-care seniors or relatively low Medicaid per diems, food costs outweighed the resulting Medicaid savings on a relatively large scale.
Study lead author Kali Thomas, PhD, assistant professor in Brown’s School of Public Health, said the findings provide guidance for state policymakers as they consider the future of their home-delivered meals programs, which are conducted under the Older Americans Act. States projected to lose money can opt to focus their efforts in ways that are more precise than an across-the-board expansion, she adds.
“We’re not proposing that all states simply increase the proportion of age-65-plus receiving meals by one percent,” Thomas says. “But if they were to target these vulnerable people who are at risk for nursing home placement, they would likely see more savings. This is a program that has the potential to save states a lot of money if it’s done correctly.”
Policymakers should consider not only the fiscal implications of providing home-delivered meals, which the study quantifies, but also the impact on individual seniors, says Thomas, who adds that she has seen the benefits anecdotally as a Meals on Wheels volunteer in Rhode Island.
The National Institute on Aging and the Agency for Healthcare Research and Quality funded the research, which is published in the October issue of Health Affairs.
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