Cease and assist.

Home modifications are underfunded 

THE ELDERLY EXPERIENCE LESS PHYSICAL and mental decline and less pain and are admitted to hospitals less frequently and for shorter periods of time when they are provided with assistive devices and their homes are modified to compensate for physical limitations, a recent study suggests. But these devices and modifications are underutilized because Medicare and most insurance providers do not cover their costs.

"People don't always get what they need," says William Mann, PhD, director of the University at Buffalo's Rehabilitation Engineering Research Center on Aging and author of the report, which was published in May in the Archives of Family Medicine.

According to Mann, third-party payors cover relatively few assistive technology devices and home environmental interventions. Moreover, the services required to evaluate a frail elder or assess the individual's home environment are not paid for by insurance, he says.

Mann studied 104 elderly people with physical disabilities living in their homes in western New York. Those in the treatment group received a combination of devices such as canes, walkers, and bath benches and environmental interventions such as ramps and lowered kitchen cabinets. People in the control group received the "usual care services" reimbursed under such programs as Medicare, Medicaid, and the Older Americans Act.

Over an 18-month period, the treatment group experienced less overall physical and cognitive decline than the treatment group. Participants in the treatment group also reported significantly less pain than their counterparts in the control group, and spent four times less on hospital and in-home nursing care.

Funded in part by AARP's Andrus Foundation and the Administration on Aging of the Department of Health and Human Services, the study was conducted at the University at Buffalo's Rehabilitation Engineering Research Center on Aging.