TOPLINE:
Table of Contents
The use of home healthcare services is common among people with dementia, especially for community-initiated care, a new analysis of Medicare data showed. Between 2010 and 2019, use of community-initiated home healthcare increased by 17%, while use of home healthcare for postacute care rose by 21%. Use decreased after 2020, which investigators said could be linked to staffing shortages in the home healthcare industry.
METHODOLOGY:
- Researchers conducted a cross-sectional analysis, including over 13 million older adults (mean age, 79.4 years; 60% women; 86% White individuals) who were enrolled for traditional Medicare and received home healthcare between 2010 and 2022.
- The frequency and duration of home healthcare spells were analyzed and compared between individuals with dementia (28%) and those without dementia (72%).
- Postacute care was defined as home healthcare instituted within 14 days of discharge from a hospital, nursing home, or other facility. All other home healthcare use was classified as community-initiated.
TAKEAWAY:
- Between 2010 and 2022, there were 30,998,653 home healthcare spells (mean, 2.2 home health spells per beneficiary). Individuals with dementia used community-initiated home healthcare more frequently than postacute care (54% vs 46%).
- Among individuals with dementia, the number of community-initiated care spells increased from 35.4 to 40.2 per 1000 beneficiaries and that of postacute care spells increased from 28.9 to 35.1 per 1000 beneficiaries (2010-2019) and then fell to 33.6 and 28.5 per 1000 beneficiaries by mid-2022, respectively.
- Between 2010 and 2019, the number of community-initiated care spells among individuals without dementia decreased by 20%, while postacute care spells decreased by 21% in this population.
- Home healthcare spells were consistently longer for individuals with dementia than those without it (47-52 days vs 44-50 days for community-initiated care and 40-43 days vs 32-34 days for postacute care).
IN PRACTICE:
“Despite increasing use of home healthcare during this time period, people may receive incomplete support for their home healthcare needs through Medicare, which is centered on needs for skilled care, or Medicaid, which entails strict asset and income tests. Decreasing rates of home healthcare use since 2020 in this high-need population point to a need for ongoing monitoring of service use and outcomes for people with dementia,” the investigators wrote.
SOURCE:
The study was led by Rachel M. Werner, MD, PhD, Perelman School of Medicine, University of Pennsylvania, Philadelphia. It was published online on May 16 in JAMA Network Open.
LIMITATIONS:
The study relied on claims data for dementia diagnosis. The COVID-19 pandemic may have disrupted healthcare utilization, potentially leading to underdiagnosis of dementia toward the study’s end. Additionally, the study only included traditional Medicare beneficiaries as those enrolled in Medicare Advantage typically use home healthcare at lower rates and for shorter periods, which may have influenced the observed trends.
DISCLOSURES:
The study was funded by the National Institute of Aging. One author reported receiving personal fees from City Block Health and Trinity Health outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Home Healthcare for Dementia Patients: A Growing Need, Facing Challenges – Q&A wiht Dr.Emily Carter
Keywords: Home Healthcare,dementia,Medicare,Elderly Care,Alzheimer’s Disease,Post-Acute Care,Community-Initiated Care,Aging in Place
Time.news recently covered a study published in JAMA Network Open, revealing concerning trends in home healthcare utilization for people with dementia. We spoke with Dr. Emily Carter, a leading geriatric care expert, to unpack these findings and understand what they mean for families and teh future of dementia care.
Time.news: Welcome, Dr. Carter. The study highlights an increase in home healthcare use, notably community-initiated care, among individuals with dementia between 2010 and 2019. Can you explain what “community-initiated home healthcare” means in this context?
Dr. Emily Carter: Certainly. Community-initiated home healthcare refers to services that are not directly tied to a recent hospital stay or facility discharge. Think of it as proactive support arranged by family members, caregivers, or even the individuals themselves to help manage daily living activities and health needs within their own homes.It frequently enough involves assistance with bathing, dressing, medication management, and skilled nursing care provided in the comfort of home rather than a clinical setting.
Time.news: The study found a rise in both community-initiated and post-acute home healthcare for dementia patients until 2019, followed by a decrease after 2020. what factors do you believe contributed to this decline?
Dr. Emily Carter: While the study suggests staffing shortages within the home healthcare industry as a likely culprit, I think the COVID-19 pandemic exacerbated several existing issues.Staffing shortages were already becoming problematic, but the pandemic substantially impacted the availability of caregivers. Fear of infection, burnout among healthcare workers, and changing priorities led to fewer individuals entering or remaining in the home healthcare workforce.Furthermore, as the study limitations noted, the pandemic may have led to underdiagnosis of dementia towards the end of the study period which could have skewed the data.
Time.news: The research indicates that individuals with dementia consistently require longer home healthcare spells than those without. why is that the case?
Dr. Emily Carter: Dementia is a progressive condition. As the disease progresses,individuals often require increasing levels of support with activities of daily living,cognitive stimulation,and skilled medical care. This can translate into a continuous need for assistance, leading to longer home healthcare spells to maintain safety, comfort, and quality of life at home.Family caregivers can easily burn out without respite.
Time.news: The study points out that Medicare’s focus on skilled care and Medicaid’s stringent financial requirements can create barriers to accessing sufficient home healthcare. What are some choice funding options or resources families can explore?
Dr. Emily carter: that’s a critical point. Navigating the financial landscape of dementia care is incredibly challenging. Some families can explore long-term care insurance policies, if they were purchased, although these can be costly. Veterans may be eligible for benefits through the Department of Veterans Affairs. Local Area Agencies on Aging can connect families with state and local programs offering financial assistance or subsidized care. exploring privately paid home health agencies still may be an option for many families.
time.news: What advice would you give to families currently navigating the challenges of finding and affording quality home healthcare for a loved one with dementia?
Dr. Emily Carter: Start planning early. Don’t wait for a crisis to begin researching home healthcare options. Connect with a geriatric care manager who can assess your loved one’s needs and develop a comprehensive care plan. Consider joining a support group for caregivers of people with dementia. These groups offer emotional support, practical advice, and a sense of community. Don’t be afraid to advocate for your loved one’s needs with healthcare providers and insurance companies. Understand the limitations of Medicare and Medicaid, and explore all available funding options. prioritize caregiver self-care. Taking care of yourself is essential for providing quality care to your loved one.
