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

Abstract

ObjectivesEvaluate the independent and interactive effects of dementia and racial/ethnic minority status on functional outcomes during a home health (HH) admission among Medicare beneficiaries. MethodsSecondary analysis of data from the Outcome and Assessment Information Set [OASIS] and billing records in a non-profit HH agency in New York. Participants were adults � 65 years old who received HH in CY 2017 with OASIS records at HH admission and HH discharge. Dementia was identified by diagnosis (ICD-10 codes) and cognitive impairment (OASIS: M1700, M1710, M1740). We used OASIS records to assess race/ethnicity (M0140) and functional status (M1800-M1870 on activities of daily living [ADL]). Functional outcome was measured as change in the composite ADL score from HH admission to HH discharge, where a negative score means improvement and a positive score means decline. ResultsThe sample included 4,783 patients, among whom 93.9% improved in ADLs at HH discharge. In multivariable linear regression that adjusted for HH service use and covariates (R 2 = 0.23), being African American (β = 0.21, 95% confidence interval [CI]: 0.06, 0.35, p = 0.005) and having dementia (β = 0.51, 95% CI: 0.41, 0.62, p<0.001) were independently related to less ADL improvement at HH discharge, with significant interaction related to further decrease in ADL improvement. Relative to white patients without dementia, African American patients with dementia (β = 1.08, 95% CI: 0.81, 1.35, p<0.001), Hispanics with

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

“…Need factors included (1) number of chronic conditions (0–27), (2) specific medical conditions that are known to increase the risk of acute care admissions 13 (in Supplementary Table S1), (3) body mass index, (4) presence of severe pain, (5) presence of unhealed pressure ulcer with open wound (i.e., ≥stage II), (6) baseline ADL limitation (composite score: 0–9), (7) presence of depressive symptoms (Patient Health Questionnaire‐2 score ≥3 or physician‐prescribed depression intervention in care plan), and (8) presence of cognitive impairment (yes/no), which was identified as “yes” if one or more items on OASIS cognitive function assessment indicated the highest level of impairment (Supplementary Table S1).…”

“…HH care facilitates early identification of clinical status change, promotes functional improvement, avoids hospitalization and emergency department (ED) visits, and prolongs independent stay at home 8‐10 . HH outcomes are related to multi‐domain factors spanning demographic and socioeconomic status, health conditions, social support, type and amount of HH services, 9‐13 and living situations. As noted in a systematic review, three studies using data from 1 to 15 HH agencies reported that living alone at home was related to both higher and lower risks of hospitalization than patients not living alone, either at home or in AL 11 .…”

“…We hypothesized that AL residents would have less ADL improvement and higher risk of hospitalization and ED visit than other HH recipients. This is because (1) HH recipients having more functional limitations 9 and cognitive impairment 10 have less ADL improvement 13 and are at higher risk of hospitalization and ED visits, 9,10 and (2) AL residents have more cognitive and functional impairments than other HH recipients 5 …”

Pain treatment and functional improvement in home health care: Relationship with dementia

“…Depending on the provider's order, HHC services can include skilled nursing (SN), physical/occupational therapy (PT/OT), social work (SW), and HHC aide assistance (HA) 25 . HHC services (e.g., symptom assessment, home exercise, and training on medication management) are important to pain management 12,26 and functional improvement 27–29 . Yet no studies have examined the extent of pain treatment among HHC patients with ADRD and the impact of pain treatment on functional outcomes in these patients.…”

Care‐Partner Support and Hospitalization in Assisted Living During Transitional Home Health Care

“…HH care includes skilled nursing (medication reconciliation, patient education, care coordination), physical/occupational therapy (home exercise and home safety training), and social work (engagement with community‐based services and insurance coverage), as well as nonskilled personal care aide assistance (house making, cooking, laundry) 5 ; all are provided in the patient's home or place of primary residency such as AL. HH care is effective at improving physical function, 6 reducing hospitalizations, 7,8 and delaying nursing home admissions 9 . AL residents commonly use HH services during post‐acute care transitions 10 .…”