Home health utilization association with discharge to community for people with dementia (original) (raw)

Modifiable risk factors for homebound progression among those with and without dementia in a longitudinal survey of community-dwelling older adults

BMC Geriatrics, 2021

Background Being homebound is independently associated with increased mortality but the homebound population is heterogeneous. In order to improve precision medicine, we analyzed potentially modifiable factors that contribute to homebound progression (from independent to needing assistance, to homebound), stratified by dementia status. Methods Using National Aging and Trends Survey (NHATS), a nationally-representative, longitudinal annual survey from 2011 to 2017 (n = 11,528), we categorized homebound progression if one transitioned from independent or needing assistance to homebound, including competing risks of institutionalization or death between 2011 and last year of data available for each unique respondent. Using proportional hazards regression, we calculated hazard ratios of potentially modifiable risk factors on homebound progression. Results Depressive symptoms, mobility impairment, and pain increased risk of homebound progression regardless of dementia status. Social isol...

Factors Associated with Home Care Outcomes among Community-Dwelling Older Adult Patients with Dementia

Dementia and Geriatric Cognitive Disorders Extra

Background: With the increase in the proportion of people with dementia (PWD), it is necessary to address dementia-related issues among older adults who live at home; however, there is no integrative review on this issue. Objectives: To describe and analyze quantitative and qualitative studies from primary sources in order to identify the factors which impact home care outcomes among PWD. Methods: A computer search of PsycINFO, MEDLINE (PubMed), and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was performed. This study was guided by Whittemore and Knafl’s integrative review method. Results: This review of the literature identified 3 main factors related to home care outcomes among PWD. These factors are environmental factors, caregiver-related factors, and social network factors. Conclusions: Further research is required to investigate the impacts of multiple social and environmental factors on home care outcomes among PWD; which can eventually be used by nu...

Comparison of Unmet Care Needs across The Dementia Trajectory: Findings from The Maximizing Independence at Home Study

Journal of Geriatrics and Palliative Care, 2014

Introduction: The aging of the population will bring with it an increase in the number of individuals with dementia living in the community. This will result in a greater demand on family caregivers and the long term care system to deliver care that is consistent with patient needs across the dementia trajectory, and requires a thorough understanding of an individual's care needs as they change over the disease course. This study compares the unmet care needs of community dwelling persons with dementia across the stages of the dementia. Methods: Cross sectional analyses were conducted using in-home assessment data collected from 254 community residing persons with dementia and their informal caregivers. Results and Discussion: Most unmet needs for patients in the early stage of disease were in the domains of safety and basic education about disease processes. Patients with moderate stage disease had the highest level of unmet needs in the domains of supervised daytime activities and caregiver's management of neuropsychiatric behaviors. Individuals with severe or end stage disease had the highest level of unmet needs in the domain of emotional distress and the caregiver's need for caregiver emotional support and respite. Reasons for unmet needs may be a consequence of a lack of knowledge about the disease process and a lack of psychosocial support resources. At all levels were evolving needs for information on the changing disease course and the need for meaningful activities. These results provide a basic overview of unmet needs by disease stage from which to build palliative care interventions for persons with dementia living at home and their family caregivers.

Home Health and Informal Care Utilization and Costs Over Time in Alzheimer's Disease

Home Health Care Services Quarterly, 2008

Objectives-To (1) compare home health and informal (unpaid) services utilization among patients with Alzheimer's disease (AD), (2) examine longitudinal changes in services use, and (3) estimate possible interdependence of home health and informal care utilization. Methods-The sample is drawn from the Predictors Study, a large, multi-center cohort of patients with probable AD, prospectively followed annually for up to 7 years in three university-based AD centers. Bivariate probit models estimated the effects of patient characteristics on home health and informal care utilization. Results-A large majority of the patients (80.6%) received informal care with a smaller proportion (18.6%) receiving home health services. Home health services utilization increased from 9.9% at baseline to 34.5% in year 4. Among users, number of days that services were provided in three-month recall increased from 21.9 to 56 days over time. Home health services utilization was significantly associated with function, depressive symptoms, being female, and not living with a spouse. Informal care utilization was significantly associated with cognition, function, comorbidities, and living with a spouse or child. Conclusions-Home health and informal care utilization relate differently to patient characteristics. Utilization of home health care or informal care was not influenced by utilization of the other.

Comparison of Resource Utilization for Medicaid Dementia Patients Using Nursing Homes Versus Home and Community Based Waivers for Long-Term Care

Medical Care, 2008

Background: Medicaid waiver home and community-based longterm care services (HCBS) may provide a partial solution to the escalating costs of long-term care. Persons with dementia can have complex caregiving needs; it is unknown whether their expenditures and resource utilization differ between community-based versus institutional settings. Objective: To compare expenditures and resource utilization for Medicaid recipients with dementia who received long-term care through a nursing home versus HCBS waivers. Design: Twelve-month cohort study. Setting: Indiana Medicaid administrative data from 2001 through 2004. Participants: Medicaid recipients with dementia who lived in the community 6 months before receiving long-term care through nursing homes (N ϭ 1534) or HCBS waivers (N ϭ 174). Measurements: Monthly inpatient and emergency department rates and total expenditures adjusted for prior use, demographics, insurance status, and comorbidities. Results: Adjusted rates of inpatient use were stable for nursing home patients (0.06) but significantly increased over 12 months for HCBS recipients (0.07-0.12; P ϭ 0.048). Adjusted total expenditures increased over 12 months from 1419to1419 to 1419to2002 for HCBS recipients (P Ͻ 0.001), but remained stable for those in nursing homes ($3413-$3336). Long-term care expenditures were on average $1688 per month higher for those in nursing homes. Conclusions: The escalation in inpatient use for HCBS waiver recipients suggests that future development of HCBS programs should consider the unique needs of persons with dementia so as to optimize their health outcomes. Despite increasing inpatient use among HCBS recipients, their overall expenditures remained significantly lower than those of nursing home patients.

Health and Functional Outcomes and Health Care Utilization of Persons With Dementia in Residential Care and Assisted Living Facilities: Comparison With Nursing Homes

The Gerontologist, 2005

Purpose: This study compares health and functional outcomes and health care utilization of persons with dementia residing in residential care/assisted living (RC/AL) facilities and nursing homes. Design and Methods: The study uses data from a longitudinal cohort study of 1,252 residents with dementia in 106 RC/AL facilities and 40 nursing homes in four states. Results: Rates of mortality; new or worsening morbidity; and change in activities of daily living, cognition, behavioral problems, depressive symptoms, social function, and withdrawal did not differ between the two settings. However, because of death or transfer, only about one half of the persons with mild dementia and one third of those with moderate to severe dementia remained in RC/AL facilities 1 year after enrollment. In addition, hospitalization rates were greater among individuals with mild dementia in RC/AL facilities, largely because of a medically unstable subgroup with high nursinghome-transfer rates. Implications: Many persons with dementia can be served equally well in either setting; however, those with major medical care needs may benefit from nursing home residence.

Multimorbidity and healthcare utilization among home care clients with dementia in Ontario, Canada: A retrospective analysis of a population-based cohort

PLoS medicine, 2017

For community-dwelling older persons with dementia, the presence of multimorbidity can create complex clinical challenges for both individuals and their physicians, and can contribute to poor outcomes. We quantified the associations between level of multimorbidity (chronic disease burden) and risk of hospitalization and risk of emergency department (ED) visit in a home care cohort with dementia and explored the role of continuity of physician care (COC) in modifying these relationships. A retrospective cohort study using linked administrative and clinical data from Ontario, Canada, was conducted among 30,112 long-stay home care clients (mean age 83.0 ± 7.7 y) with dementia in 2012. Multivariable Fine-Gray regression models were used to determine associations between level of multimorbidity and 1-y risk of hospitalization and 1-y risk of ED visit, accounting for multiple competing risks (death and long-term care placement). Interaction terms were used to assess potential effect modif...

The Association between Home Healthcare and Burdensome Transitions at the End-of-Life in People with Dementia: A 12-Year Nationwide Population-Based Cohort Study

International Journal of Environmental Research and Public Health

Background: For people with dementia, burdensome transitions may indicate poorer-quality end-of-life care. Little is known regarding the association between home healthcare (HHC) and these burdensome transitions. We aimed to investigate the impact of HHC on transitions and hospital/intensive care unit (ICU) utilisation nearing the end-of-life for people with dementia at a national level. Methods: A nested case-control analysis was applied in a retrospective cohort study using a nationwide electronic records database. We included people with new dementia diagnoses who died during 2002–2013 in whole population data from the universal healthcare system in Taiwan. Burdensome transitions were defined as multiple hospitalisations in the last 90 days (early transitions, ET) or any hospitalisation or emergency room visit in the last three days of life (late transitions, LT). People with (cases) and without (controls) burdensome transitions were matched on a ratio of 1:2. We performed condit...

Predictors of Formal Home Health Care Use in Elderly Patients after Hospitalization

Journal of the American Geriatrics Society, 1993

Objective: To prospectively study the incidence of and risk factors for home health care (HHC) use in a cohort of elderly medical and surgical patients discharged from acute care. Although HHC is commonly received by patients in this group, its predictors have not been well studied. Design: Prospective cohort study. Setting: Medical and surgical wards at a university teaching hospital, followed by 23 Medicare-certified HHC agencies in the study catchment area. Patients: 226 medical and surgical patients aged 70 years and older immediately after discharge from acute care. Measurements: HHC initiated within 14 days after hospital discharge, measured by direct review of HHC agency records. Results: The incidence of HHC initiated within 2 weeks postdischarge was 75/226 (34%). The median duration of service was 30 days (range 3-483) with a median of 3 visits per week. Four independent predictors of HHC were identified