Home Healthcare Common for People With Dementia
The use of home healthcare services is common among people with dementia, especially for community-initiated care, a new analysis of Medicare data showed. Between 2010 and 2019, use of community-initiated home healthcare increased by 17%, while use of home healthcare for postacute care rose by 21%. Use decreased after 2020, which investigators said could be linked to staffing shortages in the home healthcare industry.
METHODOLOGY:
Researchers conducted a cross-sectional analysis, including over 13 million older adults (mean age, 79.4 years; 60% women; 86% White individuals) who were enrolled for traditional Medicare and received home healthcare between 2010 and 2022.
The frequency and duration of home healthcare spells were analyzed and compared between individuals with dementia (28%) and those without dementia (72%).
Postacute care was defined as home healthcare instituted within 14 days of discharge from a hospital, nursing home, or other facility. All other home healthcare use was classified as community-initiated.
TAKEAWAY:
Between 2010 and 2022, there were 30,998,653 home healthcare spells (mean, 2.2 home health spells per beneficiary). Individuals with dementia used community-initiated home healthcare more frequently than postacute care (54% vs 46%).
Among individuals with dementia, the number of community-initiated care spells increased from 35.4 to 40.2 per 1000 beneficiaries and that of postacute care spells increased from 28.9 to 35.1 per 1000 beneficiaries (2010-2019) and then fell to 33.6 and 28.5 per 1000 beneficiaries by mid-2022, respectively.
Between 2010 and 2019, the number of community-initiated care spells among individuals without dementia decreased by 20%, while postacute care spells decreased by 21% in this population.
Home healthcare spells were consistently longer for individuals with dementia than those without it (47-52 days vs 44-50 days for community-initiated care and 40-43 days vs 32-34 days for postacute care).
IN PRACTICE:
'Despite increasing use of home health care during this time period, people may receive incomplete support for their home healthcare needs through Medicare, which is centered on needs for skilled care, or Medicaid, which entails strict asset and income tests. Decreasing rates of home healthcare use since 2020 in this high-need population point to a need for ongoing monitoring of service use and outcomes for people with dementia,' the investigators wrote.
SOURCE:
The study was led by Rachel M. Werner, MD, PhD, Perelman School of Medicine, University of Pennsylvania, Philadelphia. It was published online on May 16 in JAMA Network Open .
LIMITATIONS:
The study relied on claims data for dementia diagnosis. The COVID-19 pandemic may have disrupted healthcare utilization, potentially leading to underdiagnosis of dementia toward the study's end. Additionally, the study only included traditional Medicare beneficiaries as those enrolled in Medicare Advantage typically use home healthcare at lower rates and for shorter periods, which may have influenced the observed trends.
DISCLOSURES:
The study was funded by the National Institute of Aging. One author reported receiving personal fees from City Block Health and Trinity Health outside the submitted work.
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