Relationship of Medicare–Medicaid Dual Eligibility and Dementia With Unplanned Facility Admissions Among Medicare Home Health Care Recipients

Objective: The objective of this study was to examine the effects of dementia and Medicare–Medicaid dual eligibility on unplanned facility admission among older Medicare home health (HH) recipients. Method: This study involves a secondary analysis of data from the Outcome and Assessment Information Set (OASIS) and billing records (i.e., International Classification of Diseases, 10th Revision [ICD-10] codes) of 6,153 adults ≥ 65 years receiving HH from a nonprofit HH agency in CY 2017. Results: Among dual eligible patients with dementia, 39.3% had an unplanned facility admission of any type, including the hospital, nursing home, or rehabilitation facility. In the multivariable Cox proportional hazard model of time-to-facility admission, dual eligible patients with dementia were more than twice as likely as Medicare-only patients without dementia to have an unplanned facility admission (hazard ratio = 2.35; 95% confidence interval: 1.28, 4.33; p = .006). Discussion: Low income and dementia have interactive effects on facility admissions. Among Medicare HH recipients, dual eligible patients with dementia are the most vulnerable group for unplanned facility admission.