Patient cognitive impairment associated with higher home health care delivery costs

Health Serv Res. 2022 Jun;57(3):515-523. doi: 10.1111/1475-6773.13928. Epub 2022 Jan 23.


Objective: To assess whether home health agencies incur significantly higher care delivery costs for patients with cognitive impairment across three timeframes relevant to home health payment policy.

Data sources: Linked Medicare home health claims and patient assessments, National Health and Aging Trends Study (NHATS), and home health agency cost reports for a nationally representative sample of Medicare beneficiaries receiving home health between 2011 and 2016.

Study design: We modeled care delivery costs incurred by the home health agency as a function of patient cognitive impairment using multivariable, propensity score-adjusted, generalized linear models.

Data collection/extraction methods: We identified NHATS participants who experienced an index home health episode between 2011 and 2016 (n = 1214; weighted n = 5,856,333) and linked their NHATS survey data to standardized patient assessment and claims data for the episode, as well as cost report data for the home health agency that provided care.

Principal findings: Across the first 30, 60, and 120 days of caring for a patient with cognitive impairment, we estimate additional costs of care to the home health agency of $186.19 (p = 0.02), $282.46 (p = 0.01), and $740.91 (p = 0.04), respectively.

Conclusions: Home health agencies incur significantly higher costs when caring for a patient with cognitive impairment. As patient cognitive function is not considered in the most recent Medicare home health reimbursement model, agencies may be disincentivized from providing care to those with cognitive impairment. Policy makers and researchers should carefully monitor home health access among Medicare beneficiaries with cognitive impairment and further investigate the inclusion of patient cognitive function in future risk adjustment models.

Keywords: Medicare; cognitive function; dementia; home care services; home health.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cognitive Dysfunction* / therapy
  • Delivery of Health Care
  • Home Care Agencies*
  • Home Care Services*
  • Humans
  • Medicare
  • United States