Home health utilization association with discharge to community for people with dementia
Open accessAbstract
Introduction: The objective of this study was to identify home health utilization factors associated with successful discharge to community after home health care for patients with and without Alzheimer's disease and related dementias (ADRD). Methods: This was a retrospective study of 100% national Medicare home health data files (2016 to 2017). Multilevel logistic regression was used to study the relationship of home health utilization with a modified definition of successful discharge to community (M‐SDC) after home health (no readmission or discharge within 30 days). Significant interactions were identified using backward selection. The associations between domains were examined in a model stratified by ADRD, with and without controlling for mobility, self‐care, and caregiver assistance. Results: The cohort consisted of 535,691 patients, 18.0% with ADRD. The overall M‐SDC rate was 92.1%. The likelihood of M‐SDC was increased when physical therapy services were provided, episodes of care were longer than 15 days, and the total number of therapy visits was greater than 10. The likelihood of M‐SDC decreased when speech therapy, nursing, and home health aide services were provided and when patients were discharged early. When controlling for mobility, self‐care, and caregiver support, length of home health episode was the only characteristic that showed a significant interaction with ADRD. Discussion: The results of this study indicate that the provision of physical therapy services and moderate lengths of care and volume of visits are associated with increased likelihood of M‐SDC. A decreased likelihood of M‐SDC when speech therapy, nursing, and home health aide services are delivered may be a proxy indicator of patient acuity and disease severity and needs to be further investigated. An important next step in understanding home health access and outcomes for people with ADRD is to examine the impact of the Patient‐Driven Groupings Model on home health utilization characteristics, especially length of episodes. Highlights: Most people remain in the community after discharge from home health. Likelihood of modified successful discharge to community (M‐SDC) increased with physical therapy, longer episodes, and more than 10 visits. Likelihood of M‐SDC decreased with speech therapy, skilled nursing, home health aide visits, and early discharge. Longer home health episodes increased likelihood of M‐SDC for people with Alzheimer's disease and related dementias.
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Receipt of home health services after hospital discharge increases the likelihood of remaining in the community for at least 30 days after hospital discharge, with greater benefits from longer durations of home health care.
“Receipt of home health services after hospital discharge has been shown to increase the likelihood of remaining in the community for at least 30 days after hospital discharge, with greater benefits from longer durations of home health care. 890”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [890]
The Discussion (page unavailable) reports that longer home-health episodes were associated with a greater likelihood of remaining in the community. But the Methods > Outcome section measures the 30-day period after discharge from home health, not after hospital discharge. The study reports an association among home-health recipients, not that receiving home health itself causes an increase in that likelihood. (LLM, conf=0.90)
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Self-citation
- Authors
- Knox, S., Downer, B., Haas, A., & Ottenbacher, K. J.
- Affiliations
- Medical University of South Carolina (US)
- The University of Texas Medical Branch at Galveston (US)
- Corresponding author
- Knox, Sara
- Venue
- Alzheimer's & Dementia: Translational Research & Clinical Interventions
- Publisher
- Wiley
- Published
- 2022-01
- Volume
- 8
- Issue
- 1
- Pages
- e12341-e12341
- ISSN
- 2352-8737 (ISSN-L)
- PMC
- PMC9322826
- OpenAlex
- W4288059607
- Cited by
- 14
- References
- 20
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 1
- FWCI
- 3.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Alzheimer s & Dementia Translational Research & Clinical Interventions (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Institutes of Health (R01HD069443, P2CHD065702, K01AG058789, K01AG073538, P30AG024832, U54GM104941)
- National Institute on Aging (K01AG058789, K01AG073538, P30AG024832)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- home health care, Alzheimer's disease and related dementias, physiotherapy, length of care, speech therapy, skilled nursing care, early discharge, patient acuity
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