Late‐stage dementia is associated with decreased likelihood of successful discharge to community after home health care

Abstract

AbstractBackgroundSeveral studies have established the efficacy of home health in meeting the health care needs of people with Alzheimer’s disease and related dementias (ADRD) and in assisting them to remain in their homes, which is a key goal for the majority of older adults. However, transitioning to the community after discharge from home health poses significant challenges to patient safety and quality of care. For individuals with ADRD, these challenges are compounded by cognitive limitations and behavioral and psychological symptoms inherent to their disease. The likelihood of a person with ADRD successfully discharging to the community may depend on the severity of their dementia. The purpose of this study was to examine the association between ADRD severity and successful discharge to community (DTC) after home health.MethodThis retrospective study derived data from 100% national CMS data files from October 1, 2016 through September 30, 2017. A cohort of 140,616 Medicare beneficiaries with ADRD who received home health was identified. Successful DTC rates with associated 95% confidence intervals (CIs) were calculated for each patient characteristic. Multilevel logistic regression was used to estimate the relative risk (RR) of successful DTC after home health, by dementia severity level, adjusted for patient and clinical characteristics.ResultOverall, 72.5% of individuals had a successful DTC. Individuals in the first 5 stages of the dementia categorization scale had successful DTC rates greater than the cohort average (75.3%‐ 80.3%). Individuals in the 6th dementia categorization stage (69.2%) had successful DTC rates 3% less than the cohort average and individuals in the 7th dementia categorization stage had successful DTC rates almost 20% lower (55.9%) than the cohort average. Individuals in the 6th and 7th dementia severity categories had significantly lower risk of successful DTC (RR=0.67, 95% CI=0.65‐0.69 and RR= 0.42, 95% CI= 0.38‐ 0.46) than those in the lowest dementia severity category.ConclusionMost older adults with ADRD had a successful DTC following home health, but the likelihood for successful DTC decreased considerably with greater ADRD severity. Strategies for increasing the likelihood for successful DTC following home health among older adults with ADRD need to consider disease severity.