Home Health Quality among Hospitalized Older Adults with Alzheimer's Disease and Related Dementia: Association with Race/Ethnicity and Dual Eligibility before and during the COVID Pandemic.
Ming-Ting Yang, Helena Temkin-Greener, Peter Veazie and 1 others
PMID 38843869WHAT IT FOUND
Among older adults with dementia discharged home after hospitalization, Black, Hispanic, and dual Medicare-Medicaid patients were more often sent to below-average-quality home health agencies.
These gaps remained through the pandemic.
Key findings
01Before the pandemic, non-Hispanic Black and Hispanic beneficiaries had higher probabilities of discharge to below-average quality home health agencies than White beneficiaries, by 3.4 and 3.9 percentage points.
02Dual-eligible beneficiaries had a 2.5 percentage point higher probability of discharge to below-average quality home health agencies than non-dual beneficiaries.
03During the pandemic, the Hispanic difference decreased by 1.3 percentage points, while the dual-eligible difference increased by 0.8 percentage points.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The cohort included only fee-for-service Medicare beneficiaries, so the results may not apply to people in Medicare Advantage plans. The study could not fully account for why patients were referred to particular agencies, such as hospital referral patterns. It excluded Asian, Pacific Islander, and American Indian beneficiaries because their numbers were small. County-level adjustment may not capture differences in agency quality within the same county.
Declared interests
The supplied metadata lists non-U.S. government and NIH extramural research support. No author conflict statement is provided in the supplied article text.
The easy way to misread this
Do not read the pandemic decrease in below-average-quality discharges as evidence that referral practices improved. The study did not test the reason for the decrease and says it may reflect agency availability.