Medicare‐funded home‐based clinical care for community‐dwelling persons with dementia: An essential healthcare delivery mechanism. Issue 4 (22nd December 2021)

• Record Type: Journal Article
• Authors: Ornstein, Katherine A.; Ankuda, Claire K.; Leff, Bruce; Rajagopalan, Subashini; Siu, Albert L.; Harrison, Krista L.; Oh, Anna; Reckrey, Jennifer M.; Ritchie, Christine S.
• Is Part Of: Journal of the American Geriatrics Society. Volume 70:Issue 4(2022)
• Page Start: 1127
• Page End: 1135
• Publication Date: 2021-12-22
• Subjects: dementia -- home health -- home‐based medical care -- podiatry; Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.17621
• Languages: English
• ISSNs: 0002-8614

Abstract

Abstract: Background: Over the past decade, medical care has shifted from institutions into home settings—particularly among persons with dementia. Yet it is unknown how home‐based clinical services currently support persons with dementia, and what factors shape access. Methods: Using the National Health and Aging Trends Study linked to Medicare claims 2012–2017, we identified 6664 community‐dwelling adults age ≥ 70 years enrolled in fee‐for‐service Medicare. Annual assessment of dementia status was determined via self‐report, cognitive interview, and/or proxy assessment. Receipt of four types of home‐based clinical care (home‐based medical care (HBMC) (i.e., nurse practitioner, physician, or physician assistant visits), skilled home health care (SHHC), podiatry visits, and other types of home‐based clinical services (e.g., behavioral health)) was assessed annually. We compared age‐adjusted rates of home‐based clinical care by dementia status and determined sociodemographic, health, and environmental characteristics associated with utilization of home‐based clinical care among persons with dementia. Results: Nearly half (44.4%) of persons with dementia received any home‐based clinical care annually compared to only 14.4% of those without dementia. Persons with dementia received substantially more of each type of home‐based clinical care than those without dementia including a 5‐fold increased use of HBMC (95% CI = 3.8–6.2) and double the use of SHHC (95% CI = 2.0–2.5). In adjusted models, Hispanic/Latino persons with dementia were less likely to receive HBMC (OR = 0.32; 95% CI = 0.11–0.93). Use of HBMC, podiatry, and other home‐based clinical care was significantly more likely among those living in residential care facilities, in the Northeast and in metropolitan areas. Conclusion: Although almost half of community‐dwelling persons with dementia receive home‐based clinical care, there is significant variation in utilization based on race/ethnicity and environmental context. Increased understanding as to how these factors impact utilization is necessary to reduce potential inequities in healthcare delivery among the dementia population.