| Beginning October 1, 2000 Medicare has reimbursed home health care through the Prospective Payment System. Factors absent in this reimbursement formula are co-morbidity, depression, and social support. This comparative, exploratory study was designed to determine differences between outliers and non-outliers, with regards to co-morbidity, depression, and social support. The Theory of Bureaucratic Caring was the theoretical framework utilized.;Twenty elderly outliers, representing the entire outlier sample, and 80 elderly randomly sampled non-outliers of a large home care agency were studied. Participants completed a demographic form, the Geriatric Depression Scale - Short Form, and the Norbeck Social Support Questionnaire. Statistical analysis included the t Test, Pearson Product Moment Correlation, Spearman rho Correlation, Eta Correlation Procedure, Chi-square, and Mann Whitney test. Outliers had a high incidence of primary diagnoses requiring wound care (55%), were significantly younger (p = .001), and had significantly higher levels of the social support subscale aid (p = .05).;Co-morbidity was high for outliers and non-outliers (median: 3.00 and 4.00, respectively). Depression scores for outliers and non-outliers indicated high levels of possible depression (15% and 36%, respectively), and depression (10% and 8%, respectively). Social support scores were low for outliers and non-outliers (mean: 198.100 and 127.5375, respectively). Number of support network members was low for outliers and non-outliers (median: 4.50 and 3.00, respectively). Depression was significantly correlated with social support (r = .51 to .83) and co-morbidity (r = .33 to .49) for both groups. There was no significant difference between outliers and non-outliers for co-morbidity, depression, and total social support ( p > .05). |
