Can Older Adults Accurately Report Their Use of Physical Rehabilitation Services?

The final analytic sample was restricted to Medicare fee-for-service beneficiaries with both Part A and Part B for 12 months before the interview, so findings may not apply to Medicare Advantage enrollees, Part A only enrollees, or people with employer or private pay. The analytic sample was older, more likely to be non-Hispanic white, more highly educated, and more likely to report rehabilitation use than people excluded from the fee-for-service comparison. Medicare claims may miss rehabilitation paid by an employer plan or private payer, which can make survey reports look less accurate than they are. The study did not distinguish whether the reported rehabilitation was PT, OT, or speech therapy, nor did it distinguish the number of disciplines or visits involved. Inpatient rehabilitation combined hospital, skilled nursing homes, and inpatient rehabilitation facilities, so the finding cannot say which inpatient setting was under-reported. Accuracy declined as time since rehabilitation use increased, so a 1-year recall period is not equally reliable for recent and distant services. Seven respondents who said they did not know were excluded, and proxy respondents were included in the main analysis.

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Do not read the 90.4% agreement as meaning all older adults report rehabilitation use equally well. Inpatient rehab was substantially under-reported, and under-reporting was more likely for Black adults, adults 85 or older, those with less than high school, and proxy respondents.