# Trends in the Use of Medicare Home Health Care among Congregate Living Residents

## TL;DR

This study found that home health care use in congregate living settings increased from 2014 to 2019 and was associated with higher quality and quantity of care, though disparities remained for dually eligible and minority patients.

## Contribution

The study provides new insights into how congregate living affects Medicare home health care use and quality disparities.

## Key findings

- Home health care episodes in congregate living increased by 20.5% from 2014 to 2019.
- Patients in congregate living had higher rates of high-quality agency use and planned visits compared to those in other settings.
- Disparities in HHC quality and planned visits persisted for dually eligible and minority patients in congregate living.

## Abstract

To examine trends in home health care (HHC) use in congregate living and compare characteristics of HHC use between Medicare patients in congregate living and those in other home settings.

Retrospective cohort study describing HHC use, in and outside of congregate living, using national Medicare claims, assessment, and administrative data (2014–2019). We compared HHC use by setting, on HHC quality, planned visit quantity, referral source (post-acute or community-initiated), and recertifications. We additionally examined whether HHC patterns across settings differed by patient dual eligibility and race-ethnicity.

Traditional Medicare (TM) and Medicare Advantage (MA) HHC patients aged 67 and older in congregate living or elsewhere.

Multivariable regressions.

15.9% of HHC episodes in 2018–2019 were in congregate living, which increased 20.5% between 2014 and 2019. TM patients in congregate living were 4.4% (2.3 ppt, 95% CI: 1.7, 2.9) more likely to use high-quality agencies, had 8.7% (0.7 visits, 95% CI: 0.7, 0.8) more planned visits, were 27.6% (14.9 ppt, 95% CI: 14.7, 15.1) more likely to have community-initiated referrals, and 9.9% (3.2 ppt, 95% CI: 2.9, 3.5) more likely to be recertified compared with TM patients in other settings; differences were similar between settings among MA enrollees. Compared with their counterparts, dually eligible and racial-ethnic minoritized populations in congregate living were 2.6% (−1.5 ppt, 95% CI:−2.2,−0.8%) and 1.6% less likely (−0.9 ppt, 95% CI: −1.6, −0.3%) to use high-quality agencies, respectively, and dually eligible patients in congregate living had 6% fewer planned visits (−0.64 visits, 95% CI: −0.72, −55); these differences persisted across settings.

Congregate living may have facilitated access to higher quality and quantity of HHC, but inequitably. Further research is needed to determine the value of high-frequency community-initiated HHC referrals in congregate living.