Image of a senior man recuperating in a hospital bed

Most Medicare recipients with dementia receive post-acute care in a skilled nursing facility — despite the influence of payment reform efforts, researchers from the University of Pennsylvania say.

The investigators used Medicare data from 2013 to 2016 to compare SNF and home health use for post-acute care in these recipients over time. Their results revealed that one third (32%) of all fee-for-service Medicare beneficiaries who receive post-acute care have a dementia diagnosis. What’s more, 7 in 10 find this care in a skilled nursing facility. Overall use and trends were similar in the Medicare Advantage population.

Dementia patients making the transition from hospital to post-acute care are vulnerable to changes in post-acute care utilization driven by payment reforms, wrote lead author Robert E. Burke, M.D. But he and his colleagues were surprised to find that these post-acute care utilization patterns remained stable over time, despite major payment-reform initiatives put in place during the study period.

These included the Bundled Payments for Care Improvement in 2013, the Hospital Readmission Reduction Program (which included lower extremity joint replacement as a targeted condition in 2013), and the Comprehensive Care for Joint Replacement model in 2015, they reported. 

No changes in diagnosis groups

Another surprise: There was no change in how common diagnosis groups were treated as a result of these payment reforms. For example, there were not more patients with joint replacement discharged to home health care, Burke and colleagues wrote. 

The findings can be used to evaluate how to best meet the needs of older adults with dementia after a hospital stay, the researchers said. In prior research among the same cohort of Medicare recipients with dementia, they found that outcomes of SNF and home health care were similar for older beneficiaries with similar health profiles and a diagnosis of dementia.

“These results, in combination with our current findings, could suggest SNF is over-used in this population,” the authors suggested. “High rates of SNF use among individuals with dementia may not translate to high-value care, particularly when it comes to severe dementia at the end of life,” they wrote. 

But much more support is needed to ensure that the home environment is a feasible and safe post-acute destination for older adults with dementia, they added. 

“Otherwise, this could shift the burden of post-acute care onto families and informal caregivers at home without necessary supports,” they concluded.

The study was published this week in JAMDA.