Home Health Care and Place of Death in Medicare Beneficiaries With and Without Dementia
This study provides compelling evidence supporting the positive impact of home health care on end-of-life care, especially for individuals with dementia. It underscores the importance of early home health care initiation and advocates for policies that enhance access to these vital services for all eligible individuals.
College of Health researcher(s)
College unit(s)
Abstract
Background and Objectives
Home health care supports patient goals for aging in place. Our objective was to determine if home health care use in the last 3 years of life reduces the risk of inpatient death without hospice.
Research Design and Methods
We analyzed the characteristics of 2,065,300 Medicare beneficiaries who died in 2019 and conducted multinomial logistic regression analyses to evaluate the association between the use and timing of home health care, dementia diagnosis, and place of death.
Results
Receiving any home health care in the last 3 years of life was associated with a lower probability of inpatient death without hospice (Pr 23.3% vs 31.5%, p < .001), and this effect was stronger when home health care began prior to versus during the last year of life (Pr 22.5% vs 24.3%, p < .001). Among all decedents, the probability of death at home with hospice compared to inpatient death with hospice was greater when any home health care was used (Pr 46.0% vs 36.5%, p < .001), and this association was strongest among beneficiaries with dementia who started home health care at least 1 year prior to death (Pr 55.6%, p < .001).
Discussion and Implications
Use of home health care during the last 3 years of life was associated with reduced rates of inpatient death without hospice, and increased rates of home death with hospice. Increasing affordable access to home health care can positively affect end-of-life care outcomes for older Americans and their family caregivers, especially those with dementia.
FAQ: Home Health Care and Place of Death for Medicare Beneficiaries
What is the main finding of this study?
This study found that receiving home health care at any point during the last three years of life significantly decreased the risk of dying in an inpatient setting without hospice for Medicare beneficiaries, regardless of whether they had a dementia diagnosis.
How does home health care affect the likelihood of dying at home with hospice?
The use of home health care was associated with an increased likelihood of dying at home with hospice care. This effect was particularly strong for individuals with dementia who started receiving home health care at least one year before death.
Why might home health care lead to more deaths at home with hospice for people with dementia?
Home health care can play a crucial role in supporting caregivers of individuals with dementia. By providing training and resources, home health care can help caregivers understand disease progression and provide adequate care at home. This can empower families to choose hospice care at home when the time is right.
Are there any racial or ethnic disparities in the use of home health care and hospice?
Yes, the study found that Black and Hispanic decedents had a higher likelihood of dying at home without hospice care compared to their White counterparts. This highlights existing disparities in access to end-of-life care services for minority groups.
Does Medicare Advantage insurance impact the place of death for people with dementia?
The study found that individuals with dementia enrolled in Medicare Advantage had a higher likelihood of dying at home with hospice compared to those with traditional Medicare. This may be because hospice care is "carved out" of Medicare Advantage and paid under fee-for-service, creating a financial incentive for referrals to hospice.
What are the policy implications of this study's findings?
The study emphasizes the need for policies that increase access and equity in the use of home- and community-based care services, including both home health care and hospice care. Expanding access to these services can help more individuals achieve their end-of-life care preferences and potentially reduce healthcare costs.
What are the limitations of this study?
The study was limited by the inability to account for patient and caregiver preferences, verify the accuracy of dementia diagnoses, and identify all patients' living situations and available caregiver support. Additionally, the study did not delve into the specific reasons for home health care use or the intensity and types of services received.
What are some areas for future research?
Future research should investigate the different combinations and intensities of home health services and their relationship with patient outcomes, living situations, and caregiver support. This will provide a more nuanced understanding of the factors that influence the use of hospice and the place of death.