Abstract
In Medicare-funded home health care (HHC), one in three patients has cognitive impairment (CI), but little is known about the care intensity they receive in this setting. Recent HHC reimbursement changes fail to adjust for patient CI, potentially creating a financial disincentive to caring for these individuals. This cohort study included a nationally representative sample of 1214 Medicare HHC patients between 2011 and 2016. Multivariable logistic and negative binomial regressions modelled the relationship between patient CI and care intensity-measured as the number and type of visits received during HHC and likelihood of receiving multiple successive HHC episodes. Patients with CI had 45% (P<.05) greater odds of receiving multiple successive HHC episodes and received an additional 2.82 total (P<.001), 1.39 nursing (P=.003), 0.72 physical therapy (P=.03), and 0.60 occupational therapy visits (P=.01) during the index HHC episode. Recent HHC reimbursement changes do not reflect the more intensive care needs of patients with CI.
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