MHH Testimony Senate Finance Committee COVID-19 Flexibilities FINAL

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During the pandemic, home-based care has skyrocketed, which was necessary to help limit exposure and keep older adults safe from COVID-19. Patient preference is also shifting to care in the home over facility-based care. Now, as we look to the future, care in the home serves as an opportunity to reduce the number of older adults suffering falls each year.

Falls are the leading cause of fatal and nonfatal injuries for older Americans. Falls threaten the safety and independence of older adults, and generate enormous economic and personal costs.

Falls often occur when entering and leaving the home, while in public, and in facility-based health care settings. Older adults may suffer falls on their way to medical appointments, while picking up their prescription medications, or during a hospital stay. What if we could bring clinical care to them instead?

Moving Health Home, an alliance to advance home-based care, sees care in the home as an opportunity to address and prevent falls in older adults.

The ability for older adults to receive care in the home avoids the additional risk of suffering a fall while traveling between medical appointments, during a stay in a facility-based hospital, or while receiving a suite of clinical services that could otherwise be offered in the home.

It is difficult for a patient to recall specific factors in their physical environment that may contribute to causing a fall in the home. Importantly, when providing clinical care in the home, health professionals with specialized experience in home-based care are often trained to screen for falls risk by evaluating the environment. This is occurring in the home where it makes the most sense, not during a facility-based appointment.

As an example, when an in-home primary care physician is conducting a house call, they might take the time to clear wet leaves from the path leading to the front door. This is a seemly simple act, but one that can reduce the risk of a fall.

Increasingly, hospital-level care is being offered in the home to many patient populations, such as those with Medicare Advantage. Based on peer-reviewed research and pilot studies, we know patients in hospital at home programs are less likely to suffer from a fall than when in the facility-based hospital setting. In some cases, falls have been close to zero in hospital at home programs. If a fall is suffered, continuous monitoring is often used to immediately dispatch help.

Moving Health Home members want to see the home as a clinical site of care to give older adults the freedom to choose where they receive their care. We want policymakers to realize the many benefits that come with expanding access to care in the home, including significantly reducing the chance of suffering a fall.