Objective: 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.
Design: 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.
Setting and Participants: Traditional Medicare (TM) and Medicare Advantage (MA) HHC patients aged 67 and older in congregate living or elsewhere.
Methods: Multivariable regressions.
Results: 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.
Conclusion and Implications: 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.
