Abstract
Objectives
Hospitalized patients with dementia transitioning to post-acute care may be particularly
vulnerable to changes in post-acute care utilization driven by payment reforms; however,
use of post-acute care in this population is incompletely understood. We sought to
describe post-acute care utilization in skilled nursing facilities (SNFs) and from
home health (HH) agencies among Medicare beneficiaries with a diagnosis of dementia.
Design
Retrospective, observational study using 100% sample of Medicare beneficiaries from
2013 to 2016.
Setting and Participants
We identified hospitalizations and diagnoses using Medicare Provider Analysis and
Review (MedPAR), SNF stays using the Minimum Data Set, HH episodes using the Outcome
and Assessment Information Set, and dementia diagnoses using the Medicare Beneficiary
Summary File Chronic Conditions segment.
Methods
We calculated overall utilization and trends in post-acute care use over time, stratified
by dementia diagnosis, type of post-acute care (SNF vs HH), and payer (fee-for-service
vs Medicare Advantage).
Results
Of the 9,762,208 Medicare fee-for-service beneficiaries who received post-acute care
from 2013 to 2016, 3,155,560 (32.3%) carried a diagnosis of dementia. Rates of post-acute
care use were similar over time. More beneficiaries with a diagnosis of dementia received
post-acute care (44.2% vs 27.7%) and proportionally more SNF care (71.7% vs 49.6%).
Overall use and trends were similar in the Medicare Advantage population.
Conclusions and Implications
One-third of all fee-for-service Medicare beneficiaries receiving post-acute care
have a diagnosis of dementia, and more than 7 in 10 receive this care in an SNF. These
findings serve as a foundation for needed evaluations of how best to meet the post-hospital
needs of older adults with dementia.
Keywords
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 accessOne-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 AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of dementia subtypes in United States Medicare fee-for-service beneficiaries, 2011–2013.Alzheimers Dement. 2017; 13: 28-37
- Post-acute care--the next frontier for controlling Medicare spending.N Engl J Med. 2014; 370: 692-694
- Transitions in care in a nationally representative sample of older Americans with dementia.J Am Geriatr Soc. 2015; 63: 1495-1502
- End-of-life transitions among nursing home residents with cognitive issues.N Engl J Med. 2011; 365: 1212-1221
- Skilled nursing facility admissions of nursing home residents with advanced dementia.J Am Geriatr Soc. 2013; 61: 1645-1650
- Churning: the association between health care transitions and feeding tube insertion for nursing home residents with advanced cognitive impairment.J Palliat Med. 2009; 12: 359-362
- Rehabbed to death.N Engl J Med. 2019; 380: 408-409
- Trends in post-acute care use among Medicare beneficiaries: 2000 to 2015.JAMA. 2018; 319: 1616-1617
- Post-acute care: current state and future directions.J Am Med Dir Assoc. 2019; 20: 392-395
- The changing landscape of post-acute and rehabilitative care.J Am Med Dir Assoc. 2019; 20: 389-391
- Less intense postacute care, better outcomes for enrollees in Medicare Advantage than those in fee-for-service.Health Aff Proj Hope. 2017; 36: 91-100
- Association of discharge to home vs institutional postacute care with outcomes after lower extremity joint replacement.JAMA Netw Open. 2020; 3: e2022382
- Health care spending and utilization in public and private Medicare.Am Econ J Appl Econ. 2019; 11: 302-332
- Postacute care outcomes in home health or skilled nursing facilities in patients with a diagnosis of dementia.Health Serv Res. 2021; ([Epub ahead of print])
- Outcomes of post-acute care in skilled nursing facilities in Medicare beneficiaries with and without a diagnosis of dementia.J Am Geriatr Soc. 2021; ([Epub ahead of print])
- Family caregiving for those with and without dementia in the last 10 years of life.JAMA Intern Med. 2021; 181: 278
- Does caregiving strain increase as patients with and without dementia approach the end of life?.J Pain Symptom Manage. 2019; 57: 199-208.e2
- The disproportionate impact of dementia on family and unpaid caregiving to older adults.Health Aff Proj Hope. 2015; 34: 1642-1649
Article info
Publication history
Published online: October 10, 2021
Footnotes
This project was funded by the University of Pennsylvania Institute on Aging.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.