Home › Research › Risk factors
Home Health Delivery for Persons With Dementia: Impacts of the New Medicare Payment System
Julia G. Burgdorf, Tracy M. Mroz. Innovation in Aging, 2025-12-01
Topic: Risk, prevention and care in population studies
Abstract Medicare-funded home health care (HH) is a crucial resource helping Persons with Dementia (PwD) meet their care needs while aging in place. HH includes a mix of skilled nursing, rehabilitation, and personal care services delivered in the patient’s home and one-third of HH patients have dementia. In 2020, Medicare implemented a new HH payment system: the “Patient Driven Groupings Model” (PDGM). PDGM includes several provisions that effectively reduce reimbursement for the types of HH most used by PwD. Using 2019 and 2021 linked Medicare HH claims, patient assessment, geographic, and HH agency data, we modelled the types and intensity of services received as a function of patient dementia status and year (i.e., pre- or post-PDGM). Our sample included older adults (65+) receiving community-initiated HH in 2019 or 2021 (n = 907,553). We modelled outcomes using multivariable logistic and negative binomial regression, adjusting for patient sociodemographic characteristics, functional and clinical status, geographic location, and HH agency characteristics. Compared to pre-PDGM, PwD post-PDGM had lower odds of receiving nursing (Adjusted Odds Ratio (aOR): 0.73; 95% Confidence Interval (CI): 0.72-0.75), occupational therapy (aOR: 0.86; 95% CI: 0.84-0.88), social work (aOR: 0.76; 95% CI: 0.73-0.78), and aide services (aOR: 0.70; 95% CI: 0.68-0.72). Findings persisted following multiple sensitivity analyses, including adjusting for county-level COVID-19 infection rates. This work presents the first analysis of how HH care delivery shifted for PwD following PDGM; findings suggest unintended consequences that may threaten HH quality and the ability to safely age in place for the high-need population of community-living PwD.
Key findings
- Compared to pre-PDGM, PwD post-PDGM had lower odds of receiving nursing (Adjusted Odds Ratio (aOR): 0.73; 95% Confidence Interval (CI): 0.72-0.75), occupational therapy (aOR: 0.86; 95% CI: 0.84-0.88), social work (aOR: 0.76; 95% CI: 0.73-0.78), and aide services (aOR: 0.70; 95% CI: 0.68-0.72).
Why it matters
This study found that after Medicare's new home health payment system began, people with dementia had lower odds of receiving nursing, occupational therapy, social work and aide services. It concerns access to home health care, not treating, curing or preventing Alzheimer's disease.
New to this subject? Start with our plain-English guide: Risk factors, ranked →
Study details
- Participants907,553
- Effect sizeaOR: 0.86; aOR: 0.76; aOR: 0.70
- Evidence strengthLow
How this study scored 41/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Innovation in Aging) |
| Journal's citation record | 0 / 4 | Innovation in Aging: journal h-index 48 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 4 / 4 | 907,553 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Tracy M. Mroz: h-index 21 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | University of Washington: institution h-index 3,540 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Total | 41 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Burgdorf, J. G., & Mroz, T. M. (2025). Home Health Delivery for Persons With Dementia: Impacts of the New Medicare Payment System. Innovation in Aging. https://doi.org/10.1093/geroni/igaf122.283
Vancouver
Burgdorf JG, Mroz TM. Home Health Delivery for Persons With Dementia: Impacts of the New Medicare Payment System. Innovation in Aging. 2025. doi:10.1093/geroni/igaf122.283.
BibTeX
@article{burgdorf2025-e4557bee,
author = {Burgdorf, Julia G. and Mroz, Tracy M.},
title = {{Home Health Delivery for Persons With Dementia: Impacts of the New Medicare Payment System}},
journal = {Innovation in Aging},
year = {2025},
doi = {10.1093/geroni/igaf122.283},
url = {https://doi.org/10.1093/geroni/igaf122.283}
}
Related studies in Risk factors
Also tagged “care”
996 studies in the library carry the topic tag “care”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 996 tagged studies.