Use of Post-Acute Care by Medicare Beneficiaries With a Diagnosis of Dementia

Topic: Risk, prevention and care in population studies

Hospitalized patients with dementia transitioning to post-acute care may be particularly vulnerable to changes in post-acute care utilization driven by payment reforms; however, use of post-acute care in this population is incompletely understood. We sought to describe post-acute care utilization in skilled nursing facilities (SNFs) and from home health (HH) agencies among Medicare beneficiaries with a diagnosis of dementia. Retrospective, observational study using 100% sample of Medicare beneficiaries from 2013 to 2016. We identified hospitalizations and diagnoses using Medicare Provider Analysis and Review (MedPAR), SNF stays using the Minimum Data Set, HH episodes using the Outcome and Assessment Information Set, and dementia diagnoses using the Medicare Beneficiary Summary File Chronic Conditions segment. We calculated overall utilization and trends in post-acute care use over time, stratified by dementia diagnosis, type of post-acute care (SNF vs HH), and payer (fee-for-service vs Medicare Advantage). Of the 9,762,208 Medicare fee-for-service beneficiaries who received post-acute care from 2013 to 2016, 3,155,560 (32.3%) carried a diagnosis of dementia. Rates of post-acute care use were similar over time. More beneficiaries with a diagnosis of dementia received post-acute care (44.2% vs 27.7%) and proportionally more SNF care (71.7% vs 49.6%). Overall use and trends were similar in the Medicare Advantage population. One-third of all fee-for-service Medicare beneficiaries receiving post-acute care have a diagnosis of dementia, and more than 7 in 10 receive this care in an SNF. These findings serve as a foundation for needed evaluations of how best to meet the post-hospital needs of older adults with dementia.

Key findings

• We calculated overall utilization and trends in post-acute care use over time, stratified by dementia diagnosis, type of post-acute care (SNF vs HH), and payer (fee-for-service vs Medicare Advantage).
• Overall use and trends were similar in the Medicare Advantage population.
• These findings serve as a foundation for needed evaluations of how best to meet the post-hospital needs of older adults with dementia.

Why it matters

This study describes how Medicare beneficiaries with a dementia diagnosis used skilled nursing facilities and home health care from 2013 to 2016. It reports patterns of care use, not any treatment, cure, or prevention for Alzheimer's disease.

Study details

• Effect size32.3%; 44.2%; 27.7%
• Evidence strengthLow

Read the original

• DOI: 10.1016/j.jamda.2021.09.016
• PubMed: 34644532
• Original source →

May need a subscription OpenAlex found no free copy of the full text (checked 6 Feb 1020), so the publisher may charge for it. The PubMed abstract is free.

@article{burkerobert2022-34644532,
  author  = {Burke Robert, E. and Yao, Xu and Ritter Ashley, Z.},
  title   = {{Use of Post-Acute Care by Medicare Beneficiaries With a Diagnosis of Dementia}},
  journal = {Journal of the American Medical Directors Association},
  year    = {2022},
  doi     = {10.1016/j.jamda.2021.09.016},
  pmid    = {34644532},
  url     = {https://doi.org/10.1016/j.jamda.2021.09.016}
}

Studies this one cites

Referenced by this study and also in the alzhub library, so you can read them here.

• Prevalence of dementia subtypes in United States Medicare fee-for-service beneficiaries, 2011-2013 Alzheimer's & dementia : the journal of the Alzheimer's Association · 2016-05-10 · usefulness score 59/100 · Getting a diagnosis

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2 studies in the alzhub library list this one in their references.

• Post‐acute care transitions during COVID ‐19: Racial, ethnic, and socioeconomic differences in older adults with Alzheimer's disease and related dementia Journal of the American Geriatrics Society · 2024-03-27 · usefulness score 50/100 · Risk factors
• Post‐acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status Health Services Research · 2022-09-01 · usefulness score 41/100 · Risk factors

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