Variation in Home Healthcare Use by Dementia Status Among a National Cohort of Older Adults.

TitleVariation in Home Healthcare Use by Dementia Status Among a National Cohort of Older Adults.
Publication TypeJournal Article
Year of Publication2024
AuthorsBurgdorf, JG, Ornstein, KA, Liu, B, Leff, B, Brody, AA, McDonough, C, Ritchie, CS
JournalJournals of Gerontology. Series A Biological Sciences and Medical Sciences
ISSN Number1758-535X
KeywordsAged, Delivery of Health Care, Dementia, Home Care Services, Hospitalization, Humans, Medicare, United States

BACKGROUND: Medicare-funded home healthcare (HHC) delivers skilled nursing, therapy, and related services through visits to the patient's home. Nearly one-third (31%) of HHC patients have diagnosed dementia, but little is currently known regarding how HHC utilization and care delivery differ for persons living with dementia (PLwD).

METHODS: We drew on linked 2012-2018 Health and Retirement Study and Medicare claims for a national cohort of 1 940 community-living older adults. We described differences in HHC admission, length of stay, and referral source by patient dementia status and used weighted, multivariable logistic and negative binomial models to estimate the relationship between dementia and HHC visit type and intensity while adjusting for sociodemographic characteristics, health and functional status, and geographic/community factors.

RESULTS: PLwD had twice the odds of using HHC during a 2-year observation period, compared to those without dementia (odds ratio [OR]: 2.03; p < .001). They were more likely to be referred to HHC without a preceding hospitalization (49.4% vs 32.1%; p < .001) and incurred a greater number of HHC episodes (1.4 vs 1.0; p < .001) and a longer median HHC length of stay (55.8 days vs 40.0 days; p < .001). Among post-acute HHC patients, PLwD had twice the odds of receiving social work services (unadjusted odds ratio [aOR]: 2.15; p = .008) and 3 times the odds of receiving speech-language pathology services (aOR: 2.92; p = .002).

CONCLUSIONS: Findings highlight HHC's importance as a care setting for community-living PLwD and indicate the need to identify care delivery patterns associated with positive outcomes for PLwD and design tailored HHC clinical pathways for this patient subpopulation.

Citation Key13798
PubMed ID38071603
PubMed Central IDPMC10878244
Grant ListK01 AG081502 / AG / NIA NIH HHS / United States
P01 AG066605 / AG / NIA NIH HHS / United States