Medicare Home Health Patients Research Articles

DEFYING THE ODDS: EXCEPTIONAL HOME HEALTH AGENCIES SERVING HIGH PROPORTIONS OF BLACK PATIENTS

Abstract Healthcare providers with the highest proportions of Black patients are typically assumed to be lower quality, whether they be hospitals, nursing homes, or primary care physicians. However, little research examines the providers that “defy these odds” and rise to the top of the quality ratings. Each year, Medicare home health provides skilled nursing and therapy services to over 3 million homebound older adults with physical and cognitive impairments, and compared to the general Medicare population, Medicare home health patients are more likely to identify as Black. This mixed-methods (QUANT-->QUAL) project uses an assets-based approach as well as the tenets of the Public Health Critical Race Praxis to understand home health providers that are generally assumed to be low-quality providers – that is those who have the highest proportions of Black patients – but instead are high quality providers. This study uses star ratings and the Post-Acute Care Public Use File for home health agencies to characterize and identify agencies with high quality care and a high proportion of Black patients. Publicly available data allows us to characterize the structures and outcomes of these unique home health agencies; while primary data collection (via case studies of exceptional agencies) will allow us to report on their unique processes of care. Data collection and analyses are currently underway and will be completed by May 2023. In 2019, 28% of home health agencies were identified as having high-quality with a high proportion of Black patients, we have selected three agencies for case studies.

“They Are Lost Souls”: Medicare Home Care Nurses’ Perceptions of Medicare’s Inadequate Coverage of Homebound Persons With Alzheimer’s Disease

Alzheimer’s disease is a major and increasing cause of illness and death in the United States, imposing significant social, economic, and psychological burdens on patients and their caregivers. This article explores the perceptions of Medicare home health nurses as to the impact of Medicare home health requirements on their decisions to admit, treat, cope with, and meet patient care needs of Alzheimer’s disease patients. It presents an exploratory study, which resulted from a gap in the literature review that found only 3 studies and 1 article since 1965. The study is based on interviews of a convenience sample of 37 home care nurses from 5 home health agencies in the New York City metropolitan area. Analysis followed the grounded theory 3-stage coding of interview data: open, axial, and selective coding. This research methodology was used because it was developed for interpreting qualitative data in the absence of a pre-existing theory. Five themes emerged from interviews: (1) Most Medicare home health patients have some level of Alzheimer’s disease (AD). Medicare home care regulations: (2) restrict nurses’ admissions of persons with AD and lack a mandatory evidence-based assessment for AD; (3) restrict the care that nurses can order for persons with AD; (4) do not cover evidence-based non-pharmacological interventions for AD patients ; and (5) nurses use 3 coping strategies to deal with the restrictions: most as conformists, others as innovators, some as rebels. Policymakers are urged to consider legislation expanding coverage of home-based, evidence-based non-pharmacological interventions for persons with Alzheimer’s disease; expanding Medicare home care social work services to allow delivery of appropriate services; requiring an evidence-based Alzheimer’s disease assessment at intake and as part of the OASIS; additional reimbursement for home health agencies treating Medicare homebound persons with Alzheimer’s disease.

Prevalence and predictors of incident ADRD diagnosis following a Medicare home health episode.

Home health (HH) may be an important source of care for those with early-stage/undiagnosed Alzheimer's Disease and Related Dementias (ADRD), but little is known regarding prevalence or predictors of incident ADRD diagnosis following HH. Using 2010-2012 linked Master Beneficiary Summary File (MBSF) and HH assessment data for 40,596 Medicare HH patients, we model incident ADRD diagnosis within 1 year of HH via multivariable logistic regression. Among HH patients without diagnosed ADRD, 10% received an incident diagnosis within 1 year. In adjusted models, patients were three times more likely to receive an incident ADRD diagnosis if they had HH clinician-reported impaired overall cognition (compared to patients without reported impairment) and twice as likely if they were community-referred (compared to hospital-referred patients). There is a pressing need to develop tailored HH clinical pathways and protect access to community-referred HH to support community-living older adults with early-stage/undiagnosed ADRD.

Comparing Traditional and Disposable Negative-Pressure Wound Therapy Use by Medicare Home Health Patients.

Since 2017, home health agencies (HHAs) have received reimbursement for the provision of negative-pressure wound therapy (NPWT) using disposable, portable devices to eligible Medicare fee-for-service beneficiaries. This study aimed to describe the use of disposable NPWT (dNPWT) versus traditional, durable medical equipment-based NPWT (tNPWT) in the home health setting over time and compare the types of beneficiaries using and associated Medicare payments for NPWT separate from the home health payment bundle. Medicare fee-for-service claims were used to identify beneficiaries receiving NPWT from HHAs during home health stays. Assessment and Medicare administrative data were linked to compare characteristics between those receiving tNPWT or dNPWT and to calculate and contrast average Medicare payments for NPWT provided during the home health episode. In 2019, the vast majority of NPWT used was tNPWT (>99%). Beneficiaries using dNPWT had fewer health risk factors and used substantially less medical care than beneficiaries using tNPWT ($47,187 vs $60,440 in annual total Medicare payments per beneficiary). However, the average Medicare payments for dNPWT exceeded that of tNPWT ($1,624 vs $899) during a home health episode. Although dNPWT is well-suited for the home, its uptake has been slow. This may be attributable to HHAs' confusion in billing for dNPWT or differences in the wound types appropriate for dNPWT versus tNPWT. Policymakers should continue to monitor the use of dNPWT in the home health setting, especially given the greater average Medicare payment of dNPWT per episode.

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

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.

Painful Places: Medicare Fails Homebound Patients with Substance Abuse Disorders

There is extensive literature on the significance of substance use, misuse, and abuse among the elderly in the United States. A literature review indicates a paucity of information on the nature, significance, or impacts of the lack of substance use and abuse coverage in Medicare home health. This article presents background on the topic and an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 48 home care social workers between January 2013 and May 2015 in the New York City metropolitan area. Results indicate social workers believe substance use and abuse occurs frequently among Medicare home health patients; substance use and abuse is not assessed and treated professionally in Medicare home health; the lack of coverage in Medicare home health results in exacerbation of existing patient physical and mental health conditions, which, in turn, worsen substance use and abuse conditions; the homebound requirement and lack of coverage of transportation and personal care assistants limits home care patients ability to obtain outpatient substance use and abuse treatment; and lack of home-based assessment and treatment contributes to increased home care readmissions, re-hospitalizations, and increased caregiver burden.

Unmet family caregiver training needs associated with acute care utilization during home health care.

Medicare-certified home health agencies are required to offer family caregiver training, but little is known regarding the potential impact of this training on outcomes during home health care. We estimate the proportion of family caregivers assisting Medicare home health patients who have unmet training needs and examine whether these unmet training needs are associated with older adults' risk of acute care utilization during home health care. Observational, nationally representative cohort study. Linked National Health and Aging Trends Study, Outcome and Assessment Information Set (OASIS), Medicare Provider of Services file, and Medicare claims data from 2011 to 2016. Thousand two hundred seventeen (weighted n=5,870,905) community-living Medicare beneficiaries who received home health care between 2011 and 2016. Family caregivers' unmet training needs measured from OASIS and Medicare claims; home health patients' acute care utilization (including emergency department use and hospitalization) measured from OASIS. Rates of unmet need for training varied by activity, from 8.2% of family caregivers assisting with household chores to 16.0% assisting with self-care tasks. After controlling for older adult and home health provider characteristics, older adults whose family caregivers had an unmet need for training with any caregiving activity were twice as likely to incur acute care utilization during their home health episode (adjusted odds ratio [aOR]: 2.01, 95% confidence interval [CI]: 1.20-3.38). This relationship held across specific caregiving activities including household chores (aOR: 1.98; 95% CI: 1.13-3.46), medication management (aOR: 2.50; 95% CI: 1.46-4.26), patient supervision (aOR: 2.92; 95% CI: 1.36-6.24), and self-care tasks (aOR: 3.11; 95% CI: 1.62-6.00). Unmet training needs among family caregivers are associated with greater likelihood of acute care utilization among Medicare beneficiaries receiving home health care. Identifying and addressing family caregivers' training needs may reduce older adults' risk of acute care utilization during home health care.

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

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.

Association Between Living Arrangement and Acute Care Use in Older Medicare Home Health Patients

This secondary analysis used a 10% random sample from the national Outcome and Assessment Information Set (OASIS) of Medicare beneficiaries ≥ 65 years old who received home health (HH) care in 2017 (N=646,109). We examined the risk of hospital admission during a 60-day HH episode among Medicare home health patients in different living arrangements, including living alone at home (23.8%), living with other at home (64.8%), and residing in assisted facility (AL) facilities (11.4%). At the start of the HH episode, AL residents were older, more likely to have cognitive impairment, depressive symptoms, and limitations in activities of daily living (ADL) than those living at home at home (alone/with others). In the multivariable logistic regression model of hospital admission adjusting for demographic status (age, sex, race/ethnicity, Medicaid status), cognitive impairment, depressive symptoms, and ADL limitations, when compared to HH patients living with others at home (reference), AL residents were 15% less likely to have hospital admission (Odds Ratio [OR]=0.85, 95% Confidence Interval [CI]: 0.84, 0.88, p<0.001). HH patients living at home alone were not statistically significantly different from the reference (OR=0.99, 95% CI: 0.98, 1.01, p=0.47). HH patients in AL, despite having worse cognitive, mental, and physical function at baseline, had better outcomes than those living at home. This suggests 1) older adults living at home may have unmet health or personal care needs, and 2) synergies may exist between post-acute care through HH care and long-term care and support at AL that are critical to patient welfare.

Pain Management in Home Health Care: Relationship With Dementia and Facility Admissions

BackgroundPain is common yet under-studied among older Medicare home health (HH) patients with Alzheimer's disease and related dementias (ADRD). AimsExamine (1) the association between ADRD and severe pain in Medicare HH patients; and (2) the impact of severe pain and ADRD on unplanned facility admissions in this population. DesignAnalysis of the Outcome and Assessment Information Set (OASIS) and Medicare claims data. Settings/Participants6,153 patients ≥65 years receiving care from a nonprofit HH agency in 2017. MethodsStudy outcomes included presence of severe pain and time-to-event measures of unplanned facility admissions (hospital, nursing home, or rehabilitation facilities). ADRD was identified using ICD-10 diagnosis codes and cognitive impairment symptoms. Logistic regression and Cox proportional hazard models were used to examine, respectively, the association between ADRD and severe pain, and the independent and interaction effects of severe pain and ADRD on unplanned facility admission. ResultsPatients with ADRD (n = 1,525, 24.8%) were less likely to have recorded severe pain than others (16.4% vs. 23.6%, p < .001). Adjusting for demographics, comorbidities, mental and physical functional status, and use of HH services, having severe pain was related to a 35% increase (hazard ratio [HR] = 1.35, p = .002) in the risk of unplanned facility admission, but the increase in such risk was the same whether or not the patient had ADRD. ConclusionsHH patients with ADRD may have under-recognized pain. Severe pain is a significant independent predictor of unplanned facility admissions among HH patients.

Heterogeneity in Medicare Home Health Patients by Admission Source

Unlike other post-acute care settings, a large and growing share of Medicare Fee-For-Service patients are admitted to home health without a prior hospitalization or facility-based post-acute stay. Differences in home health patients by admission source have implications for standardizing measurement, and potentially payment, across post-acute care settings. We examined home health patients’ demographic, health, and utilization patterns when stratified by their admission source. We found that community-admitted patients were more likely to be dually eligible, have multiple home health episodes, have Alzheimer disease, and have suffered from depression. Noncommunity admission sources were associated with higher 30-day post home health admission hospitalization rates. These differences should be accounted for in properly incentivizing agencies to care for all types of patients appropriate for home health.

Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients.

Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population. To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients. Cross-sectional analysis using data from 132 home health agencies in the US. Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n=87,780). Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use. In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR=1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR=1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital. Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes, hospitalizations, and care transitions are justified.

Factors Associated With Accelerated Hospitalization and Re-hospitalization Among Medicare Home Health Patients.

Preventing hospitalizations and re-hospitalizations of older adults receiving Medicare home health (HH) services is a key goal for patients and care providers. This study aimed to identify factors related to greater risk of and earlier hospitalizations from HH, a key step in targeting preventive efforts. Data come from Medicare mandated start-of-care assessments from 87,780 HH patients served by 132 agencies in 32 states, collected from January 2013 to March 2015. Using parametric accelerated failure time (AFT) survival models, we evaluated the association between key patient and environmental characteristics and the hazard of and time until hospitalization and re-hospitalization. In total, 15,030 hospitalizations, including 6,539 re-hospitalizations, occurred in the sample within 60 days of start of HH. Factors most strongly associated with substantially greater risk of and earlier hospitalization included male gender, history of hospitalization, polypharmacy, elevated depressive symptoms, greater functional disability, primary diagnoses of heart disease, chronic obstructive pulmonary disease, and urinary tract infection, and government-controlled agency care. In addition to these factors, black race and primary diagnosis of skin wounds were uniquely related to risk of earlier re-hospitalization. Results suggest that factors collected during routine HH patient assessments can provide important information to predict risk of earlier hospitalization and re-hospitalization among Medicare HH patients. Identified factors can help identify patients at greatest risk of early hospitalization and may be important targets for agencies and care providers to prevent avoidable hospitalizations.

GREATER COGNITIVE IMPAIRMENT LINKED TO HIGHER COSTS AMONG MEDICARE HOME HEALTH PATIENTS IN THE UNITED STATES

GREATER COGNITIVE IMPAIRMENT LINKED TO HIGHER COSTS AMONG MEDICARE HOME HEALTH PATIENTS IN THE UNITED STATES

Reducing suicidal ideation in home health care: results from the CAREPATH depression care management trial.

The study evaluated the effectiveness of a depression care management intervention in reducing suicidal ideation (SI) among home health patients. Data come from the cluster-randomized effectiveness trial of the Depression Care for Patients at Home (Depression CAREPATH), an intervention that integrates depression care management into the routine nursing visits of Medicare home health patients screening positive for depression. Patients were interviewed at baseline, 3, 6, and 12-month follow-up. SI was measured using the Hamilton Rating Scale for Depression item. We compared likelihood of any level of SI between intervention and usual care patients using longitudinal logistic mixed-effects models. A total of 306 eligible patients enrolled in the trial. Among them, 70 patients (22.9%) reported SI at baseline. Among patients with SI, patients under the care of nurses randomized to CAREPATH were less likely to report SI over the study period (odds ratio = 0.51, 95% CI; 0.24-1.07), with 63.6% of usual care versus 31.3% of CAREPATH participants continuing to report SI after one year. Baseline major depression, greater perceived burdensomeness, and greater functional disability were associated with greater likelihood of SI. SI is reported in more than 10% of Medicare home health patients. The Depression CAREPATH intervention was associated with a reduction in patients reporting SI at one year, compared to enhanced usual care. Given relative low burden on nursing staff, depression care management may be an important component of routine home health practices producing long-term reduction in SI among high-risk patients. Copyright © 2015 John Wiley & Sons, Ltd.

Effect of Depression Care Management on Acute Hospitalization Risk Among Medicare Home Health Patients: The CAREPATH Trial

Acute care hospitalizations among home-health care (HHC) patients are significant and costly adverse outcomes, but there are few evidence-based interventions to reduce risk of hospitalization in HHC. Depression is common among home health patients, is often inadequately treated, and increases risk of hospitalization and other adverse outcomes. The purpose of this study was to evaluate the effectiveness of a depression care management intervention in reducing risk of acute care hospitalization among older HHC patients.

Clinical Effectiveness of Integrating Depression Care Management Into Medicare Home Health

ImportanceAmong older home health care patients, depression is highly prevalent, is often inadequately treated, and contributes to hospitalization and other poor outcomes. Feasible and effective interventions are needed to reduce this burden of depression.ObjectiveTo determine whether, among older Medicare Home Health recipients who screen positive for depression, patients of nurses receiving randomization to an intervention have greater improvement in depressive symptoms during 1 year than patients receiving enhanced usual care.Design, Setting, and ParticipantsThis cluster randomized effectiveness trial conducted at 6 home health care agencies nationwide assigned nurse teams to an intervention (12 teams) or to enhanced usual care (9 teams). Between January 13, 2009, and December 6, 2012, Medicare Home Health patients 65 years and older who screened positive for depression on routine nursing assessments were recruited, underwent assessment, and were followed up at 3, 6, and 12 months by research staff blinded to intervention status. Patients were interviewed at home and by telephone. Of 502 eligible patients, 306 enrolled in the study.InterventionsThe Depression Care for Patients at Home (Depression CAREPATH) trial requires nurses to manage depression at routine home visits by weekly symptom assessment, medication management, care coordination, education, and goal setting. Nurses’ training totaled 7 hours (4 onsite and 3 via the web). Researchers telephoned intervention team supervisors every other week.Main Outcomes and MeasuresDepression severity, assessed by the 24-item Hamilton Scale for Depression (HAM-D).ResultsThe 306 participants were predominantly female (69.6%), were racially/ethnically diverse (18.0% black and 16.0% Hispanic), and had a mean (SD) age of 76.5 (8.0) years. In the full sample, the intervention had no effect (P = .13 for intervention × time interaction). Adjusted HAM-D scores (Depression CAREPATH vs control) did not differ at 3 months (10.5 vs 11.4, P = .26) or at 6 months (9.3 vs 10.5, P = .12) but reached significance at 12 months (8.7 vs 10.6, P = .05). In the subsample with mild depression (HAM-D score, <10), the intervention had no effect (P = .90), and HAM-D scores did not differ at any follow-up points. Among 208 participants with a HAM-D score of 10 or higher, the Depression CAREPATH demonstrated effectiveness (P = .02), with lower HAM-D scores at 3 months (14.1 vs 16.1, P = .04), at 6 months (12.0 vs 14.7, P = .02), and at 12 months (11.8 vs 15.7, P = .005).Conclusion and RelevanceHome health care nurses can effectively integrate depression care management into routine practice. However, the clinical benefit seems to be limited to patients with moderate to severe depression.Trial Registrationclinicaltrials.gov Identifier: NCT01979302

Medicare Constrains Social Workers' and Nurses' Home Care for Clients with Alzheimer's Disease

The Medicare home health prospective payment system (PPS) has existed for 13 years, yielding significant profits to providers. However, studies indicate many unresolved questions about whether PPS improves patient quality of care, is cost-effective, and reduces patient levels of unmet need. In addition, PPS has undermined the provision of social work home health services. The article presents the views of 29 home health care nurses regarding the impact ofPPS on their care decisions for people with Alzheimer's disease and their caregivers. The nurses identify Alzheimer's disease symptom management and psychosocial needs as phantoms, omnipresent below the surface but not attended to by home care clinicians. The interviews support the greater involvement of social workers to more adequately address the psychosocial needs of Medicare home health patients. The article contends that the current failure to simultaneously address the cost, needs, and quality-of-life issues of people with Alzheimer's disease who are cared for at home is analogous to the end-of-life care situation before passage of the Medicare Hospice Benefit. A collaborative demonstration project--social work and nursing--is proposed to determine how PPS might better address quality of life and costs of home-based people with Alzheimer's disease and their caregivers.

Diagnosed Depression Among Medicare Home Health Patients: National Prevalence Estimates and Key Characteristics

Objectives: This study estimated the prevalence of diagnosed depression among elderly Medicare fee-for-service home health patients and identified demographic, functional, and care utilization characteristics associated with the diagnosis. Methods: Data from the 2007 National Home and Hospice Care Survey were analyzed to generate nationally representative estimates. Chi square and Wald tests, corrected for the sampling design, tested for differences in categorical and continuous measures, respectively. Results: Nationally, 6.4% (N=42,192) of the study population received a diagnosis of depression, which was associated with younger age (p=.016), lack of a primary caregiver other than the home care agency (p<.001), a lower likelihood of receiving medical social services (p=.010), and a greater likelihood of using antidepressants (p<.001). Conclusions: The rate of diagnosed depression was higher than the rate found in a previous study but lower than rates in studies that used diagnostic interviews or screening tools. Diagnosed depression was associated with a limited number of patient characteristics. (Psychiatric Services 62:538–540, 2011)

Diagnosed Depression Among Medicare Home Health Patients: National Prevalence Estimates and Key Characteristics

This study estimated the prevalence of diagnosed depression among elderly Medicare fee-for-service home health patients and identified demographic, functional, and care utilization characteristics associated with the diagnosis. Data from the 2007 National Home and Hospice Care Survey were analyzed to generate nationally representative estimates. Chi square and Wald tests, corrected for the sampling design, tested for differences in categorical and continuous measures, respectively. Nationally, 6.4% (N=42,192) of the study population received a diagnosis of depression, which was associated with younger age (p=.016), lack of a primary caregiver other than the home care agency (p<.001), a lower likelihood of receiving medical social services (p=.010), and a greater likelihood of using antidepressants (p<.001). The rate of diagnosed depression was higher than the rate found in a previous study but lower than rates in studies that used diagnostic interviews or screening tools. Diagnosed depression was associated with a limited number of patient characteristics.