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Use of Post-Acute Care by Medicare Beneficiaries With a Diagnosis of Dementia

  • Robert E. Burke
    Correspondence
    Address correspondence to Robert E. Burke, MD, MS, University of Pennsylvania, Medicine, 423 Guardian Drive, 1232 Blockley Hall, Philadelphia, PA 19104, USA.
    Affiliations
    Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA

    Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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  • Yao Xu
    Affiliations
    Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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  • Ashley Z. Ritter
    Affiliations
    Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, USA
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Published:October 10, 2021DOI:https://doi.org/10.1016/j.jamda.2021.09.016

      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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