More Medicare Beneficiaries With Dementia Are Using Home Health Care

Home health use is high among Medicare beneficiaries with dementia but was disrupted during the COVID-19 pandemic, according to findings published in JAMA Network Open.

More people with dementia are choosing to live at home and receive care in the community rather than living in a nursing home or institutional setting.

Researchers collected institutional claims from the 100% Medicare Provider Analysis and Review (MedPAR), and Master Beneficiary Summary File (MBSF) databases. Beneficiaries (N=13,604,086) aged 68 years or older enrolled in Medicare between 2010 and 2022 were evaluated for home health care spells.

The beneficiaries with (27.7%) and without (73.3%) dementia were aged mean (SD) 82.2 (7.5) and 78.4 (7.5) years; 61.9% and 59.9% were women; 84.3% and 86.4% were White; and 17.0% and 11.1% had dual eligibility, respectively.

A total of 30,998,653 home health spells occurred during the study period, in which 12,073,801 occurred among patients with dementia. More home health care spells were initiated by the community for individuals with dementia than those without dementia (53.8% vs 41.3%) whereas more were initiated for postacute care for those without dementia than those with dementia (58.7% vs 46.3%), respectively.

Home health spells increased between 2010 and 2019 by 16.8% and 21.4% for community-initiated and postacute care spells, respectively. Use of home health was low for individuals without dementia and decreased over time (between 2020 and 2022) by 20.1% and 20.7% for community-initiated and postacute care spells, respectively.

Patients with dementia had a median home health care spell duration for community-initiated care of 47 to 52 days and for postacute care of 40 to 43 days between 2010 and 2019. The median length of spell increased between 2020 and 2022 to 55 days for community-initiated care and 48 days for postacute care.

Patients without dementia had shorter home health care spells. For community-initiated care, the median duration was between 44 and 50 days in 2010 to 2019 and 53 days between 2020 and 2022. For postacute care, the median duration was between 32 and 34 days in 2010 to 2019 and 42 days between 2020 and 2022.

Adjusting for sociodemographic characteristics did not alter these trends substantially.

The study authors concluded, “Decreasing rates of home health care use since 2020 in this high-need population point to a need for ongoing monitoring of service use and outcomes for people with dementia.”

This study was limited, as the disruptions from the COVID-19 pandemic likely decreased the rate of dementia diagnoses, so some patients with dementia may have been categorized as not having dementia.

This article originally appeared on Psychiatry Advisor