By Olivia Olson
In “Breaking Down Silos to Improve the Health of Older Adults,” Richard Green, Patricia Harris, and Anthony Orlando make the case for Medicare coverage of home safety renovations to minimize injurious falls. Falling is the number one cause of injury and seventh leading cause of death in adults ages 65 and older. Over a quarter of that population falls annually, with approximately a third of those falls resulting in medical treatment or lifestyle changes. Unfortunately, however, today’s elderly are the most indebted in history and frequently lack the resources to invest in the non-urgent measures “devices to call for help, grab bars, ramps, shower seats, and other modifications for wheelchair accessibility” that would allow them to safely age in place and minimize the severity of falls.
In a 2015 study conducted by Eriksen, Greenhalgh-Stanley, and Engelhardt, home safety renovations “reduce[d] the probability of a serious fall by 21.8 percentage points.” In addition to significantly lowering the risk of injury, these installations could lead to significant savings: “each dollar invested in home renovations would save $1.29 in medical expenditures.” Although these installations would reduce the likelihood of injury and improve quality of life, the elderly “have difficulty affording these renovations due to their fixed incomes and declining access to credit” and may struggle to secure qualified installation. The researchers thus propose that Medicare fund these renovations, “reaping dollar-for-dollar savings in its own budget as well as improving public health significantly.”
While precedent for medical expenditure in home improvements is slim, these home safety renovations seem reasonably encompassed within the “home health services” mentioned in the Medicare bill and the emphasis that President Johnson placed on “health expenses ‘in the home.’” Medicare has the financial capacity to install these additions and a vested financial interest in reducing expenditure on emergency care. Adults 65 and older represent 15% of the population yet “account for 34% of the country’s healthcare expenditure.” Green et al. outline three potential approaches costing .03%, .36%, or 1.49%, respectively, of the 2020 net Medicare budget.
The first option is a pilot program experiment with 100,000 beneficiaries to “test the efficiency and cost-effectiveness of home safety renovations more rigorously.” It would cost approximately $258 million in 2020 ($308 million by 2029) only .03% of the 2020 net Medicare budget. The second option proposes the renovation of homes for all new enrollees. Given that those eligible may live with someone who already had renovations installed, only approximately 2/3 of new enrollees would require renovations. Thus the total cost would be an approximate $2.9 billion in 2020 ($3.3 billion by 2029)–.36% of the 2020 net Medicare budget. Finally, Medicare could offer to renovate the homes of all enrollees, which would cost $12.3 billion in 2020 ($12.6 billion by 2029) and reflect 1.49% of the 2020 net Medicare budget.
Green, Harris, and Orlando conclude that “Medicare has both the legal and budgetary capacity to make this investment” and in so doing, would “extend the quality of life” of older Americans without imposing additional financial burdens. These live-saving renovations would allow the elderly to more safely age in place and minimize the frequency and severity of injurious falls.