Skilled home healthcare utilization and outcomes for older adults with dementia: A scoping review.

Objectives: This study aims to summarize the existing research literature examining Medicare-skilled home health (HH) utilization and clinical outcomes for persons with dementia (PwD). We sought to answer the following questions: (1) How is dementia defined and classified in the HH literature? (2) What associations have been observed between dementia status and patterns of HH utilization? (3) What associations have been observed between dementia status and HH outcomes?

Methods: Using Arksey and O'Malley's framework for scoping reviews, we searched PubMed, Google Scholar, and select relevant journals for quantitative studies conducted in the United States between 2000 and 2023 examining Medicare HH use and outcomes for PwD. We describe and compare approaches to classify dementia, identify findings related to HH utilization and outcomes supported by the preponderance of evidence, and comment on existing gaps and areas of ambiguity in the literature.

Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice.

Importance: Transitions in care settings following live discharge from hospice care are burdensome for patients and families. Factors contributing to risk of burdensome transitions following hospice discharge are understudied.

Objective: To identify factors associated with 2 burdensome transitions following hospice live discharge, as defined by the Centers for Medicare & Medicaid Services.

Using Natural Language Processing to Identify Home Health Care Patients at Risk for Diagnosis of Alzheimer's Disease and Related Dementias.

This study aimed to: (1) validate a natural language processing (NLP) system developed for the home health care setting to identify signs and symptoms of Alzheimer's disease and related dementias (ADRD) documented in clinicians' free-text notes; (2) determine whether signs and symptoms detected via NLP help to identify patients at risk of a new ADRD diagnosis within four years after admission. This study applied NLP to a longitudinal dataset including medical record and Medicare claims data for 56,652 home health care patients and Cox proportional hazard models to the subset of 24,874 patients admitted without an ADRD diagnosis. Selected ADRD signs and symptoms were associated with increased risk of a new ADRD diagnosis during follow-up, including: motor issues; hoarding/cluttering; uncooperative behavior; delusions or hallucinations; mention of ADRD disease names; and caregiver stress.

HomeADScreen: Developing Alzheimer's disease and related dementia risk identification model in home healthcare.

Background: More than 50 % of patients with Alzheimer's disease and related dementia (ADRD) remain undiagnosed. This is specifically the case for home healthcare (HHC) patients.

Objectives: This study aimed at developing HomeADScreen, an ADRD risk screening model built on the combination of HHC patients' structured data and information extracted from HHC clinical notes.

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

Introduction: 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.

Methods: 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.

Results: Among HH patients without diagnosed ADRD, 10% received an incident diagnosis within 1 year.

Improving transitions and outcomes of sepsis survivors (I-TRANSFER): a type 1 hybrid protocol.

Background: This protocol is based on home health care (HHC) best practice evidence showing the value of coupling timely post-acute care visits by registered nurses and early outpatient provider follow-up for sepsis survivors. We found that 30-day rehospitalization rates were 7 percentage points lower (a 41% relative reduction) when sepsis survivors received a HHC nursing visit within 2 days of hospital discharge, at least 1 more nursing visit the first week, and an outpatient provider follow-up visit within 7 days compared to those without timely follow-up. However, nationwide, only 28% of sepsis survivors who transitioned to HHC received this timely visit protocol.

COVID-19 Sero-Prevalence and Risk Factors in a Sample of Community Health Center Employees in New York State.

Objective: To document COVID-19 sero-prevalence, prior testing, symptom experiences, and risk factors in a sample of community health center (CHC) workers.

Methods: Descriptive statistics and log-binomial regression were used to analyze an electronic employee survey linked with COVID-19 antibody results. The sample included 378 employees who completed the survey; 325 had complete lab data.

Clinical and Demographic Profiles of Home Care Patients With Alzheimer's Disease and Related Dementias: Implications for Information Transfer Across Care Settings.

Home health care (HHC) clinicians serving individuals with Alzheimer's disease and related dementias (ADRD) do not always have information about the person's ADRD diagnosis, which may be used to improve the HHC plan of care. This retrospective cohort study examined characteristics of 56,652 HHC patients with varied documentation of ADRD diagnoses. Data included clinical assessments and Medicare claims for a 6-month look-back period and 4-year follow-up.

Survival in hospice patients with dementia: the effect of home hospice and nurse visits.

Background: Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospice, or experiences a live discharge or long length of stay.

Objective: Examine how home hospice and nurse visit frequency relate to dying in hospice within the Medicare-intended 6-month period.

Free-Text Documentation of Dementia Symptoms in Home Healthcare: A Natural Language Processing Study.

Background: Little is known about symptom documentation related to Alzheimer's disease and related dementias (ADRD) by home healthcare (HHC) clinicians.

Objective: This study: (1) developed a natural language processing (NLP) algorithm that identifies common neuropsychiatric symptoms of ADRD in HHC free-text clinical notes; (2) described symptom clusters and hospitalization or emergency department (ED) visit rates for patients with and without these symptoms.

Method: We examined a corpus of -2.

Live Discharge From Hospice Due to Acute Hospitalization: The Role of Neighborhood Socioeconomic Characteristics and Race/Ethnicity.

Background: Acute hospitalization is a frequent reason for live discharge from hospice. Although risk factors for live discharge among hospice patients have been well documented, prior research has not examined the role of neighborhood socioeconomic characteristics, or how these characteristics relate to racial/ethnic disparities in hospice outcomes.

Objective: To examine associations between neighborhood socioeconomic characteristics and risk for live discharge from hospice because of acute hospitalization.

Sepsis Survivors Transitioned to Home Health Care: Characteristics and Early Readmission Risk Factors.

Objective: To profile the characteristics of growing numbers of sepsis survivors receiving home healthcare (HHC) by type of sepsis before, during, and after a sepsis hospitalization and identify characteristics significantly associated with 7-day readmission.

Design: Cross-sectional descriptive study. Data sources included the Outcome and Assessment Information Set (OASIS) and Medicare administrative and claims data.

Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia.

Objectives: The end-of-life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia.

A Conceptual Framework for Examining Healthcare Access and Navigation: A Behavioral-Ecological Perspective.

This paper introduces a conceptual framework for investigating individual ability to navigate healthcare in the contexts of the built environment, social environment, and healthcare infrastructure in which a person is embedded. Given the complexity of healthcare delivery in the United States, consumers are expected to have an increasingly sophisticated set of skills in order to effectively navigate and benefit from the healthcare resources available to them. Addressing barriers to navigation in vulnerable populations may be essential to reducing health disparities.

Driving Status and Transportation Disadvantage Among Medicare Beneficiaries.

Transportation disadvantage may have important implications for the health, well-being, and quality of life of older adults. This study used the 2015 National Health Aging Trends Study, a nationally representative study of Medicare beneficiaries aged 65 and over ( = 7,498), to generate national estimates of transportation modalities and transportation disadvantage among community-dwelling older adults in the United States. An estimated 10.

Individual and Environmental Determinants of Provider Continuity Among Urban Older Adults With Heart Failure: A Retrospective Cohort Study.

Continuity in patient-provider relationships is important to providing high-quality care for older adults with chronic conditions. We investigated individual and environmental determinants of provider continuity for office-based physician visits among urban older adults with heart failure. We linked Medicare claims with data on neighborhood characteristics for a retrospective cohort of community-dwelling Medicare beneficiaries with heart failure in New York City ( = 50,475).

An international perspective on improving occupational conditions for direct care workers in home health.

The occupational health and safety of direct care workers in the home health setting has been the focal point of a somewhat scarce, though highly important, body of research. Although the demand for home care services continues to expand with the rapidly growing population of older adults worldwide, home care workers - such as home health aides and personal care attendants - do not have the same level of protections by workplace safety policies such as those implemented in hospitals and nursing homes. This commentary synthesizes international perspectives on the occupational health and safety of home care workers, including the problem of workers' rights violations and abuse by clients and their families.

Neighborhood Environment and Disparities in Health Care Access Among Urban Medicare Beneficiaries With Diabetes: A Retrospective Cohort Study.

Older adults' health is sensitive to variations in neighborhood environment, yet few studies have examined how neighborhood factors influence their health care access. This study examined whether neighborhood environmental factors help to explain racial and socioeconomic disparities in health care access and outcomes among urban older adults with diabetes. Data from 123 233 diabetic Medicare beneficiaries aged 65 years and older in New York City were geocoded to measures of neighborhood walkability, public transit access, and primary care supply.

The Homecare Aide Workforce Initiative: Implementation and Outcomes.

Improved training and support are thought to improve retention among direct care workers. However, few studies have examined actual retention. This study examined satisfaction and retention among home health aides enrolled in the "Homecare Aide Workforce Initiative" (HAWI) at three New York agencies.

Can the care transitions measure predict rehospitalization risk or home health nursing use of home healthcare patients?

The Care Transitions Measure (CTM) was designed to assess the quality of patient transitions from the hospital. Many hospitals are using the measure to inform their efforts to improve transitional care. We sought to determine if the measure would have utility for home healthcare providers by predicting newly admitted patients at heightened risk for emergency department use, rehospitalization, or increased home health nursing visits.

The role of patient activation in improving blood pressure outcomes in Black patients receiving home care.

Variations in patients' self-management knowledge, skills, and confidence as measured by the Patient Activation Measure (PAM) have been linked to variations in health behavior and outcomes. In a randomized trial, we tested two blood pressure (BP) control interventions, one grounded in activation principles. Study participants were Black home care patients (N = 587) with uncontrolled hypertension.

Environmental factors associated with primary care access among urban older adults.

Disparities in primary care access and quality impede optimal chronic illness prevention and management for older adults. Although research has shown associations between neighborhood attributes and health, little is known about how these factors - in particular, the primary care infrastructure - inform older adults' primary care use. Using geographic data on primary care physician supply and surveys from 1260 senior center attendees in New York City, we examined factors that facilitate and hinder primary care use for individuals living in service areas with different supply levels.

Patient activation and disparate health care outcomes in a racially diverse sample of chronically ill older adults.

The Patient Activation Measure (PAM) assesses people's ability to self-manage their health. Variations in PAM score have been linked with health behaviors, outcomes, and potential disparities. This study assessed the relative impacts of activation, socio-demographic and clinical factors on health care outcomes in a racially diverse sample of chronically ill, elderly homecare patients.