Activities of Daily Living of Home Healthcare Patients

Abstract

Activities of daily living (ADLs) is an important measure of the quality of care provided in home healthcare (HHC), but few studies describe the ADLs of HHC patients. The objectives of this study were to (1) describe the types and levels of ADL dependency among patients receiving home care, (2) identify the risk factors for severe ADL dependency at admission, and (3) identify the predictors of ADL improvement during a HHC stay. This was a secondary data analysis of a 5% random sample (n=105,654) of the national Outcome and Assessment Information Set (OASIS-C) for the year 2013. The dependent variables were severe ADL dependency level at admission and ADL improvement from admission to discharge. About two-thirds (65%) of the patients (n = 99,991) had severe ADL dependency (dependence in 7 or more ADLs) at admission. Older age, female gender, and impaired decision-making were associated with severe ADL dependency on admission. Of the 105,654 patients, 58.1% (n = 89,997) experienced ADL improvement. ADL improvement was associated with increasing home health care length of stay, being female, and prior inpatient stay. Clinicians, policy makers and agencies could focus on modifiable characteristics to achieve the goal of ADL improvement. Interest in examining the characteristics of patients receiving home health care (HHC) has increased over the years (Medicare Performance Advisory Commission [MedPAC], 2018), perhaps because of the rise in use and costs associated with HHC as a site for post-acute care (PAC) (Jones et al., 2016). The ability to perform activities of daily living (ADLs) is a key patient characteristic that has drawn attention to the utilization and outcomes of HHC

Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations

“…The nine ADL items, each on a Likert scale, was standardized using the corrected Likert approach to the same range (0–1) and summed up (range of composite score: 0–9) 12 . The corrected Likert approach is a statistically sound 25,26 and commonly used approach to measure composite ADL function in HH 12,14,27,28 . ADL change was measured by subtracting the composite ADL admission score from the composite ADL discharge score, where a negative score indicates ADL improvement, and a positive score indicates ADL decline.…”

Functional outcome in home health: Do racial and ethnic minority patients with dementia fare worse?

“…Yet, the effects of HH on ADL improvement has been much variant among racial/ethnic minorities and for persons living with dementia [18,[27][28][29]. A large body of literature documented consistent and adverse disparities among racial and ethnic minorities as compared to whites in prevalence and outcomes of dementia, including adequate use of skilled services, medications and other interventions, quality of care, and morality [30].…”

Relationship of Medicare–Medicaid Dual Eligibility and Dementia With Unplanned Facility Admissions Among Medicare Home Health Care Recipients

“…This study adds to the small but growing body of literature on the socioeconomic disparities in outcomes among Medicare HH recipients (Fortinsky et al, 2014;Joynt Maddox et al, 2018;Osakwe et al, 2019), and finds, for the first time, the significant interacting effect between dementia and Medicaid eligibility on unplanned facility admissions. The complex comorbidities in patients with dementia call for a person-centered approach for HH care, where a personalized package of multiprofessional services (i.e., type, volume, intensity) are provided to address the different chronic conditions that cause facility admissions and to prolong independent stay at home (Callahan & Schubert, 2014;Wang et al, 2016).…”

“…The principal finding of this study was that although having dementia only or dual eligibility only was not significantly associated with unplanned facility admissions, patients with both dementia and Medicaid eligibility had more than twofold higher probability of unplanned facility admission, compared with Medicareonly HH care patients without dementia. Cognitive impairment and dual eligibility status were significant independent predictors of higher risk of facility admissions in previous studies with Medicare HH patients (Fortinsky et al, 2014;Joynt Maddox et al, 2018;Ma et al, 2017;Osakwe et al, 2019). National data have shown that people who earn less than 200% or less of the federal poverty level reported poorer perceived health status, greater food insecurity, more difficulty paying monthly bills and for medications, and more delay in seeking care (Cohen & Villarroel, 2015; National Center for Health Statistics, 2018)-all of which may lead to poor health outcomes such as facility admissions (Benyamini, 2011;Gundersen & Ziliak, 2015;Weissman et al, 1991).…”