Background: People living with dementia frequently use Medicare skilled home health care and have unique usage patterns as compared to people without dementia, but little is known about variation in measured quality of home health care received by this population.
Methods: Using 2021 Medicare Fee-for-Service Claims data, we examined receipt of high-quality home health (i.e., care from an agency with a star rating > 3.5) as determined by two publicly available measures: the Quality of Patient Care Star Rating (based on standardized clinical status measures) and the Patient Survey Star Rating (based on satisfaction with care reported by patients or caregivers). For each quality measure, we mapped the county-level high-quality-home health agency utilization rate among people living with dementia and compared differences in utilization of high-quality home health agencies by dementia status.
Results: We found significant county-level variability in utilization of high-quality home health. When quality was operationalized based on clinical status measures (i.e., Quality of Patient Care Star Rating), dementia patients did not receive care from lower quality agencies. However, when quality was operationalized based on satisfaction with care (i.e., Patient Survey Star Ratings), people living with dementia were less likely than those without dementia to receive care from high-quality home health agencies.
Conclusions: These findings highlight variability in receipt of high-quality home health care among people living with dementia nationally and suggest a need for further investigation as to what constitutes high-quality home health care in this population. To ensure home health meets the unique care needs of people living with dementia, policy makers should work to ensure quality measures are better aligned with the needs of people living with dementia, incentivize access to high-quality home health care where services are limited, and promote systems to improve family caregiver identification and engagement with home health care.
Keywords: dementia; quality measurement; skilled home health care.
© 2026 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.