Effect of Family Caregiver Need for Training on Medicare Home Health Care

Abstract

Research ObjectiveTo assess whether and how family caregiver need for training affects the number and type of visits received during a Medicare home health episode, an issue of policy relevance due to a new mandate requiring Medicare‐funded home health providers to train family caregivers.Study DesignCross‐sectional analysis of 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 file. Multivariable logistic and negative binomial models were used to model the effect of family caregiver need for training on specific caregiving activities on the number and type of visits received during a Medicare home health episode. Family caregiver need for training was drawn from home health clinician reports included in the patient assessment; home health visit type/number was drawn from Medicare claims. Analyses were limited to home health patients receiving family caregiver assistance with each specific caregiving activity.Multivariable logistic regressions were used to model the odds of receiving any nursing, therapy, aide, or training visits during a Medicare home health episode, and multivariable negative binomial regressions were used to model the expected number of total, nursing, therapy, aide, or training visits during a Medicare home health episode. Propensity score adjustment was used to produce causal estimates. All models adjusted for patient sociodemographic characteristics and health and functional status during home health, as well as home health provider characteristics. All models were weighted to account for complex survey design and to produce nationally representative estimates.Population Studied1217 (weighted n = 5 870 905) community‐dwelling older adults who participated in the NHATS from 2011‐2015 and received Medicare‐funded home health within one year of NHATS interview.Principal FindingsAmong patients receiving self‐care help from a family caregiver, the odds of any therapy visits are 71% greater (P = .04) and the odds of any aide visits are 213% greater (P = .02) if the family caregiver was identified as needing training. Among patients receiving medication management help from a family caregiver, the odds of any nursing visits are 302% greater (P = .04) and, among those who receive nursing visits, there are an expected additional 1.04 nursing visits (P = .03) if the family caregiver was identified as needing training. Family caregiver need for task‐specific training did not significantly predict the odds of any training visit nor the expected number of training visits received.ConclusionsFamily caregivers’ need for training on specific caregiving tasks was associated with greater resource utilization (home health visits) during Medicare home health episodes. This relationship was amplified for caregiver tasks and home health visits that address similar care needs (eg, caregiver need for training on self‐care and home health personal care aide visits).Implications for Policy or PracticeFindings support the call from advocates and researchers for greater support of family caregivers relating to increased access to training resources. Additionally, as home health providers comply with the recent CMS mandate to offer training to family caregivers, they should consider prioritizing training interventions which focus on caregiving tasks most closely tied to resource utilization: self‐care and medication management.Primary Funding SourceNational Institutes of Health.