Medicare Skilled Home Health Care Quality: Are We Measuring What Matters for People Living With Dementia?

TL;DR

People with dementia often use Medicare home health care, but they are less likely to receive high-quality care compared to other beneficiaries, highlighting a need for better quality measures.

Contribution

This study reveals disparities in home health care quality for people with dementia and questions the relevance of current quality metrics for this population.

Findings

34% of Medicare beneficiaries with dementia used home health care in 2021.

People with dementia were consistently less likely to use high-quality home health agencies at the county level.

Current quality measures may not reflect care quality for people with dementia due to their progressive functional decline.

Abstract

People living with dementia frequently use Medicare skilled home health care to meet their care needs at home, but little is known about variation in care quality for this population. Using 100% 2021 Medicare Claims data, we examined receipt of high-quality home health as determined by the 1) Quality of Patient Care Star Rating and 2) Patient Survey Star Rating among fee-for-service beneficiaries with dementia. Of the over 1.6 million Medicare fee-for-service beneficiaries with dementia in 2021, 34% used home health. We found significant county-level variability in utilization of high-quality home health. Within a given county, people living with dementia were consistently less likely to use high-quality home health agencies, regardless of whether quality was measured using the Quality of Patient Care Star Rating or the Patient Survey Star Rating. These findings highlight disparities in care quality received by persons living with dementia and underscore the limited utility of existing home health quality measures for this population. Specifically, quality measures focusing on functional improvement are unlikely to meaningfully reflect care quality for people living with dementia experiencing progressive functional decline as part of their disease. Additional work is needed to optimize care quality and customize quality measures to the unique care needs and experiences of people living with dementia.