Abstract
Objectives
To evaluate the association between home health (HH) services, including skilled nursing
(SN), physical therapy (PT), occupational therapy, social work (SW), and homemaking
aide assistance with the hazard of unplanned facility admissions among Medicare patients
with and without Alzheimer's disease and related dementias (ADRD).
Design
Analysis of the Outcome and Assessment Information Set and billing records.
Setting
A not-for-profit HH agency serving multiple counties in New York State.
Participants
Adults ≥65 years old who received HH from January 1, 2017 to December 31, 2017.
Measures
Outcome was time from HH start of care to an unplanned facility admission of any type,
including the hospital, nursing home, and rehabilitation facility. Independent variables
included weekly intensity (visits/week, hours/week) of SN, PT, occupational therapy,
SW, and, homemaking aide assistance separately. ADRD was identified by diagnosis (International Classification of Diseases, Tenth Revision codes in billing records) and cognitive impairment assessment (Outcome and Assessment
Information Set).
Results
Of the sample (N = 6153), 14.9% had an unplanned facility admission. In multivariable
Cox proportional hazard models that adjusted for time-varying effects of HH intensity
and covariates, receiving the highest intensity of SN (3.3 visits of 2.78 hours per
week) and PT (2.5 visits of 2 hours per week) was related to up to a 54% and 86% decrease,
respectively, in the hazard of unplanned facility admission among patients with ADRD
(n = 1525), and decreases of 56% and 90%, respectively, among patients without ADRD
(n = 4628). Receiving any SW was related to 40% decreased in the hazard of facility
admission in patients without ADRD only. Other HH services were not consistently related
to the risk of facility admission.
Conclusions and Implications
Receiving a higher intensity of SN and PT was associated with reduced hazards of unplanned
facility admission among HH patients with and without ADRD. Policies should ensure
that patients with ADRD receive a sufficient amount and appropriate mix of HH services.
Keywords
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Article info
Publication history
Published online: December 23, 2019
Footnotes
There was no funding directly associated with this work.
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
