Expanding Meals on Wheels for Seniors Could Save
Money for Many States
Meals on Wheels helps some
Medicaid-receiving seniors stay out of nursing homes, saving 26 of 48
states money allowing more seniors to stay in their own homes
Doing better by doing good
Kali Thomas, researcher and Meals on Wheels volunteer, is
beginning a randomized study to quantify the quality of life
impact of expanding meal programs for seniors an ironic
research opportunity made possible by the federal sequester.
Credit: Mike Cohea/Brown University
Oct. 7, 2013 - Home-delivered
meals bring not only food to seniors but also the opportunity to remain
in their homes. A new study by Brown University public health
researchers projects that if every U.S. state in the lower 48 expanded
the number of seniors receiving meals by just 1 percent, 1,722 more
Medicaid recipients avoid living in a nursing home and most states would
experience a net annual savings from implementing the expansion.
Pennsylvania would see the greatest
net savings $5.7 million as Medicaid costs for nursing home care
dropped more than costs rose for delivering the additional meals. But
every state is different. Florida would see a net cost of nearly $11.5
million instead. Overall, 26 states would see a net savings according to
the analysis published in the October issue of the journal Health
Affairs, while 22 would end up spending more.
Every state would enable more
seniors, who could live independently except for meals, to remain in
their homes regardless of whether they are on Medicaid.
Study lead author Kali Thomas,
assistant professor (research) in the Brown University School of Public
Health, said the study provides guidance for state policymakers as they
the consider the future of their home-delivered meals programs, which
are conducted under the Older Americans Act.
We wanted to provide a roadmap for
people, Thomas said.
for the Lower 48
A 1-percent increase in seniors who receive meals would cost money in
states with lighter gray shadings, including a lot in Florida but less
in Oregon. The 26 darker shaded states, especially those in black, could
reduce Medicaid costs enough to save money.State by state
To do the study, Thomas and
co-author Vincent Mor, the Florence Pirce Grant Professor of Community
Health, looked at several key pieces of data, including how many seniors
in each state receive home-delivered meals and how much it costs each
state to provide those meals.
She and Mor also looked at nursing home
and Medicaid data to estimate the number of seniors that Medicaid
maintains in nursing homes who are low-care, meaning they may have the
functional capabilities to live at home. Finally they looked at the per
diem Medicaid pays in each state for seniors to live in nursing homes.
The results allowed them to
estimate the incremental cost of providing meals to 1 percent more
seniors in each state, the number of additional seniors on Medicaid who
would no longer need to live in nursing homes, and how much less
Medicaid would therefore spend in each state.
Across the country, the 1 percent
expansion would bring meals to 392,594 more seniors at a cost of more
than $117 million. Because 1,722 seniors would no longer have to live in
nursing homes on Medicaid, total Medicaid savings would total $109
The reason why the additional food
delivery costs outstrip Medicaid savings nationwide, even though most
states would save money on a net basis, is that 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.
In states like California and
Florida where a 1-percent increase in the 65-plus population is a lot of
people, it will cost those states a lot more to feed them, Thomas said.
But, as she and Mor wrote in
Health Affairs, Our analyses suggest that 26 states with high
Medicaid nursing home per diem reimbursement rates, a large proportion
of low-care [nursing home residents on Medicaid], and a relatively small
population of older adults, could save money.
Thomas said states projected to
lose money can opt to focus their efforts in ways that are more precise
than an across-the-board expansion.
Were not proposing that all
states simply increase the proportion of age 65 plus receiving meals by
1 percent, she said. 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 its done correctly.
More than money
Policymakers should consider not
only the fiscal implications of providing home-delivered meals, which
the study quantifies, but also the impact on individual seniors, said
Thomas, who has seen the benefits anecdotally as a Meals on Wheels
volunteer in Rhode Island.
The quality of life argument is
really important, but its not been shown, empirically, Thomas said.
The National Institute on Aging
(grant P01 AG-027296) and the Agency for Healthcare Research and Quality
(T32, HS-000011) funded the research.
Source: Brown University,
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