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
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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.
