Improving the delivery of health and social care to “dual eligible” older adults in the community: Lessons from the HOME study

Numerous states are engaged in efforts to better provide for the complex health and social care needs of the “dual-eligible” (Medicare-Medicaid) population. In California, the Coordinated Care Initiative (CCI) offers the complete continuum of acute, primary, institutional and community-based care through a single benefit package administered by an organized service delivery system. The Helping Older-adults Maintain independencE (HOME) study investigates how older adult “dual-eligibles” have managed a fragmented network of informal and formal care, along with unlinked medical care, to continue to live independently at home. Implementation of the CCI lends urgency to efforts to understand more about their immediate health, social and information needs. In-depth interviews were conducted over two years with more than three dozen “dual-eligible” older adults and their caregivers. Information was gathered about the composition and quality of their health and social care networks, and changes experienced over time. Data were transcribed and independently coded to identify key patterns and themes.

We find that the health and social care needs of these vulnerable older adults are complex and inextricably linked. For some, the CCI holds the promise of reducing fragmentation and improving coordination of services. For others, the transition to a new delivery system is a threat to their fragile, yet familiar, status quo. Any service delivery changes need to be handled with careful attention to the specific needs of the individual. Getting the right package of services and supports may require multiple attempts and more than a “one size fits all” approach.