The Impact of Family Support on Health Care Utilization After Inpatient Care

Background: Effective post-acute care following an inpatient stay is important to high-quality care, as it has been shown to prevent readmissions and complications. It has been argued that the presence of a family member serves as a substitute for formal care; however, there is very little research quantifying the impact of informal caregivers on patterns of post-acute health care utilization. We leverage health plan administrative data collected under managed Medicare coverages to explore the impact of informal caregivers on post-acute care and recovery. Methods: Our population was Medicare-eligible members who had an inpatient admission in 2014–2015. Our “treatment” variable was the presence of another adult in the home; the outcome variables of interest include use of post-acute care (skilled nursing facility, home health care), intensity and reuse of inpatient care (length of stay, readmissions), emergency department visits after discharge and overall health care expenditures. In this pilot work, we use the term “spouse” to indicate another adult in the home to provide care to Medicare members postdischarge. We imputed the presence of a spouse by matching covered individuals by address (distinct to the apartment unit). Results: We seek to determine how the presence of a spouse in the home, and the spouse’s health status, affects transition from an inpatient setting. Our hypothesis is that the presence of a healthy spouse reduced the probability that post-acute care was needed and reduced the probability of emergency department visits and inpatient readmissions after discharge, resulting in lower overall expenditures. The presence of a spouse in poor health may actually increase the rate of post-acute care, relative to single members, because the need for transition care is less defined. Conclusion: By understanding the impact of spousal support, we can better target transition care to improve patient outcomes. This pilot work provides preliminary data in support of survey funding to create better controls for family and friend support postdischarge