TY - JOUR
T1 - Medicare-funded home-based clinical care for community-dwelling persons with dementia
T2 - An essential healthcare delivery mechanism
AU - Ornstein, Katherine A.
AU - Ankuda, Claire K.
AU - Leff, Bruce
AU - Rajagopalan, Subashini
AU - Siu, Albert L.
AU - Harrison, Krista L.
AU - Oh, Anna
AU - Reckrey, Jennifer M.
AU - Ritchie, Christine S.
N1 - Funding Information:
The National Health and Aging Trends Study (NHATS) is sponsored by the National Institute on Aging (grant number NIA U01AG032947) and is conducted at the Johns Hopkins University. This study was supported by National Institute on Aging P01AG066605 (Drs Katherine A. Ornstein and Christine S. Ritchie), K76AG064427 (Dr Claire K. Ankuda), K23AG066930 (Dr Jennifer M. Reckrey), K24AG062785 (Dr Kelley), and P30AG028741.
Publisher Copyright:
© 2021 The American Geriatrics Society.
PY - 2022/4
Y1 - 2022/4
N2 - 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.
AB - 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.
KW - dementia
KW - home health
KW - home-based medical care
KW - podiatry
UR - http://www.scopus.com/inward/record.url?scp=85121634705&partnerID=8YFLogxK
U2 - 10.1111/jgs.17621
DO - 10.1111/jgs.17621
M3 - Article
C2 - 34936087
AN - SCOPUS:85121634705
VL - 70
SP - 1127
EP - 1135
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
IS - 4
ER -