Healthcare Costs and Utilization of Vulnerable Elderly People Reported to Adult Protective Services for Self‐Neglect

Abstract

OBJECTIVES: To assess differences between diagnoses, healthcare utilization, and healthcare costs of vulnerable elderly people reported to Adult Protective Services for self-neglect and those of matched controls. DESIGN: A case-control study of 131 self-neglect cases and 131 matched controls. SETTING: All participants were patients in a public hospital geriatrics program. PARTICIPANTS: Adult Protection Services referred the self-neglect cases to an interdisciplinary geriatric medicine team. The controls were patients who used the same source of geriatric medical services and were matched on race or ethnicity, sex, and age. MEASUREMENTS: Diagnoses, healthcare utilization, and Medicare reimbursable costs were compared in cases and controls for 1 year before and 1 year after the case medical referral. RESULTS: Mental disorders were diagnosed more frequently in the self-neglect group than in the control group. Self-neglecters had lower healthcare utilization and medical costs than controls in the year before the medical referral, but utilization and costs were similar in the two groups in the year after the referral. CONCLUSION: This study provides evidence that, once self-neglecters are brought into the healthcare system, they are no more expensive than other similar patients. This result has important public policy implications and fills an important gap, because there is no published literature describing the financial effect of self-neglect on the healthcare system.

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