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).
Analysis of the Outcome and Assessment Information Set and billing records.
A not-for-profit HH agency serving multiple counties in New York State.
Adults ≥65 years old who received HH from January 1, 2017 to December 31, 2017.
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).
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- 2018 Alzheimer's Disease Facts and Figures.(Available at:)https://www.alz.org/media/HomeOffice/Facts%20and%20Figures/facts-and-figures.pdfDate accessed: August 23, 2019
- World Alzheimer Report 2010: The global economic impact of dementia.(Available at:)https://www.alz.co.uk/research/files/WorldAlzheimerReport2010.pdfDate accessed: August 23, 2019
- Dementia and co-occurring chronic conditions: A systematic literature review to identify what is known and where are the gaps in the evidence?.Int J Geriatr Psychiatry. 2017; 32: 357-371
- Transitions in care for older adults with and without dementia.J Am Geriatr Soc. 2012; 60: 813-820
- Quality of life in people with cognitive impairment: Nursing homes versus home care.Int Psychogeriatr. 2015; 27: 815-824
- Use of Services by Community-Dwelling Patients With Dementia: A Systematic Review.Am J Alzheimer Dis Other Demen. 2011; 26: 195-204
- Home Health Quality Reporting Program: Home Health Services.(Available at:)https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/index.htmlDate accessed: August 23, 2019
- A data book: Health care spending and the Medicare program, June 2019.MedPAC, Washington, DC2019: 110-112 (Available at:)http://www.medpac.gov/Date accessed: August 23, 2019
- Depression prevalence and treatment among older home health services users in the United States.Arch Gerontol Geriatr. 2017; 75: 151-157
- Complexity in geriatric home healthcare.J Healthc Qual. 2009; 31: 34-43
- Long-term care providers and service users in the United States: Data from the national study of long-term care providers, 2013‒2014.Vital Health Stat Ser 3. 2016; (1–105): x-xii
- The future of home health care: A strategic framework for optimizing value.Home Health Care Manag Pract. 2016; 28: 262-278
- The prevalence, reasons, and risk factors for hospital readmissions among home health care patients: A systematic review.Home Health Care Manag Pract. 2017; 30: 83-92
- Risk Factors for Repeated Hospitalizations Among Home Healthcare Recipients.J Healthc Qual. 2003; 25: 4-11
- Inverse dose-response relationship between home health care services and rehospitalization in older adults.J Am Med Dir Assoc. 2019; 20: 736-742
- Additional psychometric evaluation of the Outcomes and Assessment Information Set (OASIS).Home Health Care Serv Q. 2001; 18: 49-62
- Misidentification of dementia in Medicare claims and related costs.J Am Geriatr Soc. 2019; 67: 269-276
- Predictors of functional capacity changes in a U.S. population of Medicare home health care patients with heart failure.Arch Gerontol Geriatr. 2012; 54: e300-e306
- Time-varying covariates and coefficients in Cox regression models.Ann Transl Med. 2018; 6: 121
- “We don't have the infrastructure to support them at home”: How health system inadequacies impact on long-term care admissions of people with dementia.Health Policy. 2017; 121: 1280-1287
- Perceptions of home health nurses regarding suffering, artificial nutrition, and hydration in late-stage dementia.Home Healthc Now. 2016; 34: 478-484
- Development and testing of the Dementia Symptom Management at Home (DSM-H) program: An interprofessional home health care intervention to improve the quality of life for persons with dementia and their caregivers.Geriatr Nurs. 2016; 37: 200-206
- Effect of preceding home-visit nursing on time to discharge in hospitalization for the treatment of behavioural and psychological symptoms of dementia among patients with limited familial care.Psychogeriatrics. 2018; 18: 36-41
- Home health nurses' perspectives and care processes related to older persons' frailty and depression: A mixed method pilot study.J Community Health Nurs. 2018; 35: 118-136
- Hospitalization in community-dwelling persons with Alzheimer's disease: Frequency and causes.J Am Geriatr Soc. 2010; 58: 1542-1548
- Familial caregivers' experiences with home-visit nursing for persons with dementia who live alone.Psychogeriatrics. 2019; 19: 3-9
- Trends in Medicare home health care use: 1997–2001.Health Aff (Millwood). 2003; 22: 146-156
- Changes in Medicare home health care use and practices in rural communities: 1997 to 2001.J Aging Health. 2005; 17: 351-362
- Impact of changes in Medicare home health care reimbursement on month-to-month home health utilization between 1996 and 2001 for a national sample of patients undergoing orthopedic procedures.Med Care. 2006; 44: 870-878
- Changes in regional variation of Medicare home health care utilization and service mix for patients undergoing major orthopedic procedures in response to changes in reimbursement policy.Health Serv Res. 2009; 44: 1232-1252
- The differential impact of Medicare home health care policy on impaired beneficiaries.J Policy Pract. 2008; 7: 3-22
- Medicare home health payment reform may jeopardize access for clinically complex and socially vulnerable patients.Health Aff (Millwood). 2014; 33: 946-956
- Mental health services for homebound elders from home health nursing agencies and home care agencies.Psychiatr Serv. 2006; 57: 567-569
- The critical association between mental health disorders and medical status: Depression intervention use indicates a two-fold risk for medical events in older American home care patients.J Gerontol Nurs. 2016; 42: 42-55
Published online: December 23, 2019
There was no funding directly associated with this work.
The authors declare no conflicts of interest.
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.