scholarly journals The Impact of Cognitive Impairment on Resource Utilization During Medicare Home Health Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 260-260
Author(s):  
Julia Burgdorf ◽  
Jennifer Wolff
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cognitive Impairment ◽  
Resource Utilization ◽  
Home Health Care ◽  
Cognitive Status ◽  
Home Health ◽  
Payment System ◽  
Health Payment ◽  
The Relationship

Abstract Older adults with cognitive impairment have unique care needs that often lead to greater levels of health care utilization. Prior work suggests that older adults with cognitive impairment access home health care at higher rates; yet, recent Medicare home health payment system revisions exclude patient cognitive status when determining risk adjustment. This research examines the relationship between patient cognitive status and resource utilization during Medicare home health care. We examine 1,217 (weighted n=2,134,620) community-dwelling older adults who received Medicare-funded home health between 2011-2016, using linked nationally representative survey data from the National Health and Aging Trends Study (NHATS), home health patient assessment data, Medicare claims data, and Medicare Provider of Services files. We use weighted, multivariable negative binomial regressions to model the relationship between patient dementia status and the expected number of total visits and number of each visit type (nursing, therapy, and aide) during home health. Models adjusted for patient sociodemographic characteristics and health and functional status during home health, as well as home health provider characteristics. Among Medicare home health patients, the presence of cognitive impairment during home health is associated with 2.87 additional total visits (p<0.001), 1.27 additional nursing visits (p<0.01), and 1.23 additional therapy visits (p=0.04) during the home health episode. Findings suggest that recent revisions to the Medicare home health payment system may disincentivize home health care for older adults with dementia and/or financially penalize home health providers whose patient populations have a greater dementia burden.

scholarly journals Home Health Registered Nurses’ Experiences With Financial Exploitation of Older Women With Cognitive Impairment

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 701-701
Author(s):  
Carol Rogers ◽  
Lisa DeSpain ◽  
Janet Wilson
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cognitive Impairment ◽  
Health Care Providers ◽  
Home Health Care ◽  
Elder Abuse ◽  
Home Health ◽  
Care Providers ◽  
Financial Exploitation ◽  
Data Saturation

Abstract Older adults diagnosed with cognitive impairment (CI) who live at home are at high risk for FE due to dependence on caregivers and diminishing cognitive and financial capacities. Health care providers are mandated reporters for elder abuse, that includes financial exploitation (FE), one of the seven types of older adult maltreatments. Twenty Home Health Care Nurses (HHRN) of older adults in Oklahoma were interviewed to discover their understanding and experiences with FE. Transcripts were analyzed by conventional content analysis. Line-by-line codes were generated inductively and codes were grouped into categories and themes until data saturation was reached. Five themes emerged: Red Flags, Familiar Offenders, Dire Consequences, Barriers/Facilitators, Doing Better. Conclusions: HHRNs are an untapped resource to provide suggestions for improvements of FE detection/reporting of older adults with CI and to help formulate policies, procedures, strategies to improve coordination and communication among healthcare, law enforcement, and social service systems.

scholarly journals The Relationship Between Anticholinergic Medications and Mini-Cog Scores in Older Adults Receiving Home Health Care

2009 ◽  
Vol 24 (9) ◽  
pp. 673-690 ◽  
Author(s):  
Susan L. Lakey ◽  
Peggy S. Odegard ◽  
Travis E. Sonnett ◽  
Stephen M. Setter ◽  
Soo Borson
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Home Health Care ◽  
Home Health ◽  
Anticholinergic Medications ◽  
The Relationship

The Home Health Groupings Model: Should Historical Practice Shape Future Payment?

2017 ◽  
Vol 29 (2) ◽  
pp. 126-129 ◽  
Author(s):  
Teresa Lee ◽  
Melissa O’Connor
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Practice Patterns ◽  
Prospective Payment System ◽  
Home Health ◽  
Payment System ◽  
Patient Assessment ◽  
Assessment Data ◽  
Health Payment ◽  
Historical Practice

In November 2016, the Centers for Medicare and Medicaid Services published a report commissioned from Abt Associates titled “Medicare Home Health Prospective Payment System: Case-Mix Methodology Refinements, Overview of the Home Health Groupings Model.” The report presents a proposal to dramatically change Medicare payment for home health care. Based on Medicare claims and home health patient assessment data from 2013, the proposal and its approach raise issues and questions about whether historical practice patterns in home health care provide optimal grounding for a redesign of the home health payment system of the future.

scholarly journals Patient Cognitive Impairment Associated With Greater Care Intensity During Medicare Home Health Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 188-188
Author(s):  
Julia Burgdorf ◽  
Kathy Bowles
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Home Health Care ◽  
Home Health ◽  
Cognitively Impaired ◽  
Medicare Beneficiaries ◽  
Assessment Data ◽  
Care Needs ◽  
Nationally Representative ◽  
Health Payment

Abstract Medicare beneficiaries with cognitive impairment are more likely to access home health care than those without such impairment, and an estimated 1 in 3 Medicare home health patients has diagnosed dementia. However, recent changes to the Medicare home health payment system do not adjust for patients’ cognitive impairment. To the extent that cognitive impairment prompts higher intensity care, this could create a financial disincentive for providers serving this patient population. We draw on a nationally representative sample of 1,214 (weighted n=5,856,333) community-living Medicare beneficiaries who received home health care between 2011-2016. We measure care intensity by the number and type of visits received during an index home health care episode. We model care intensity as a function of patient cognitive impairment during the episode, measured via clinician reports in standardized patient assessment data. In propensity score adjusted, multivariable models holding all covariates at their means, home health patients with identified cognitive impairment received a significantly greater number of visits. During the index home health episode, cognitively impaired patients received an additional 2.82 total visits (95% CI: 1.32-4.31; p<0.001), 1.39 nursing visits (95% CI: 0.49-2.29; p=0.003), 0.72 physical therapy visits (95% CI: 0.06-1.39; p=0.03), and 0.60 occupational therapy visits (95% CI: 0.15-1.05; p=0.01). Findings suggest that recent changes to Medicare home health care reimbursement do not reflect the more intensive care needs of patients with cognitive impairment, and may threaten access to care for these individuals.

scholarly journals Caregivers’ Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting

2019 ◽  
Vol 7 (4) ◽  
pp. 561-569
Author(s):  
Jo-Ana D Chase ◽  
David Russell ◽  
Meridith Rice ◽  
Carmen Abbott ◽  
Kathryn H Bowles ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Family Caregivers ◽  
Learning Strategies ◽  
Home Health Care ◽  
Home Health ◽  
Barriers To Learning ◽  
Telephone Interviews ◽  
Qualitative Descriptive ◽  
Training And Support

Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.

scholarly journals Effect of Demographic and Health Dynamics on Cognitive Status in Mexico between 2001 and 2015: Evidence from the Mexican Health and Aging Study

Geriatrics ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. 63
Author(s):  
Silvia Mejia-Arango ◽  
Jaqueline Avila ◽  
Brian Downer ◽  
Marc A. Garcia ◽  
Alejandra Michaels-Obregon ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cognitive Impairment ◽  
Cardiovascular Diseases ◽  
Educational Attainment ◽  
Access To Health Care ◽  
Sociodemographic Factors ◽  
Cognitive Status ◽  
Access To Health ◽  
Mexican Adults

Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.

Depression Screening and Interventions for Older Home Health Care Patients

2011 ◽  
Vol 23 (6) ◽  
pp. 435-445 ◽  
Author(s):  
Colleen Delaney ◽  
Richard Fortinsky ◽  
Lorraine Doonan ◽  
Rita L. W. Grimes ◽  
Pearson Terra-Lee ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Home Care ◽  
Home Health Care ◽  
Education Program ◽  
Self Efficacy ◽  
Home Health ◽  
Depression Screening ◽  
Program Outcomes ◽  
The Impact

The increasing prevalence of depression in elderly home health care patients led to a statewide initiative in Connecticut to enhance evidence-based depression treatment for older adults. A training curriculum on depression screening and interventions was developed and disseminated to 25 home care professionals representing 14 agencies in Connecticut using a train-the-trainer model. Home care trainers included nurses and social workers. This article describes Phase I curriculum design and initial evaluation of the impact of the training on the preparation of trainers to provide depression care education at their home care agencies. Several evaluation measures, including an appraisal of the self-reported attitudes and self-efficacy of home care professionals towards depressed older adults, a pre/post-test to assess the trainers’ knowledge, and willingness of trainers to implement the education program at their agencies were used to assess program outcomes. Participants’ self-efficacy levels in screening and caring for depressed older adults was significantly increased following the education program compared to immediately before the education program (t, (24) = -4.204; p < .001).

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