Medicare Spending and the Adequacy of Support With Daily Activities in Community-Living Older Adults With Disability

Abstract

Background: Identifying factors that affect variation in health care spending among older adults with disabilities may reveal opportunities to better address their care needs while offsetting excess spending. Objective: To quantify differences in total Medicare spending among older adults with disability by whether they experience negative consequences due to inadequate support with household, mobility, or self-care activities. Design: Observational study of in-person interviews and linked Medicare claims. Setting: United States, 2015. Participants: 3716 community-living older adults who participated in the 2015 National Health and Aging Trends Study and survived 12 months. Measurements: Total Medicare spending by spending quartile in multivariable regression models that adjust for individual characteristics. Results: Negative consequences were experienced by 18.3% of older adults with household disability, 25.6% with mobility disability, and 20.0% with self-care disability. Median Medicare spending was higher for those who experienced negative consequences with household ($4,866 vs. $4,095), mobility ($7,266 vs. $4,115) and self-care disability ($10,935 vs. $4,436) versus those who did not. In regression-adjusted analyses, differences in median spending did not vary appreciably for older adults who experienced negative consequences in household activities ($338: 95% CI: $−768-$1,444) but was greater for those with mobility ($2,309: 95% CI: $208-$4,409) and self-care disability ($3,187: 95% CI: $432-$5,942). At the bottom spending quartile, differences were observed for self-care only ($1,460: 95% CI: $358-$2,561). No differences were observed at the top spending quartile. Limitations: This observational study cannot establish causality. Conclusion: Inadequate support with mobility and self-care activities is associated with higher Medicare spending, especially at the middle and lower end of spending, which creates the possibility that better supporting the care needs of older adults could offset some Medicare spending.

Social Vulnerability and Medical Complexity Among Medicare Beneficiaries Receiving Home Health Without Prior Hospitalization

“…By reducing payments for home health episodes that are not being used to meet a short-term, postacute care need, these payment changes may threaten older adults’ ability to meet their care needs in the community setting. This possibility is especially concerning given that unmet care needs among community-dwelling older adults have been linked to increased Medicare spending ( 27 ) and risk of hospitalization and institutionalization ( 28–30 ). Additionally, our finding that community-admitted patients are disproportionately reliant on support from family and unpaid caregivers suggests that reducing reimbursement for community admissions to home health care may have important consequences for both patients and their family caregivers.…”

Patient-Reported Social and Behavioral Determinants of Health and Estimated Risk of Hospitalization in High-Risk Veterans Affairs Patients

“…Our findings contribute to a growing body of literature examining the association between SDH factors and hospitalization, including studies highlighting the critical roles of social support and neighborhood socioeconomic status (SES). 3 , 50 , 51 , 52…”

“…There is increasing recognition that social and behavioral determinants of health (SDH)—the personal circumstances and environmental factors that shape individuals’ conditions of daily life—explain meaningful variation in clinical and economic outcomes. 1 , 2 , 3 From a societal perspective, addressing SDH factors could increase the effectiveness of prevention and treatment efforts, health care use, and health expenditures. 4 , 5 Clinician recognition of patients’ SDH vulnerabilities creates opportunities to offer social service referrals and targeted interventions for high-risk patients.…”

Receipt of Posthospitalization Care Training Among Medicare Beneficiaries’ Family Caregivers

“…Family caregivers are often involved in supporting older adults throughout posthospitalization care. 8 , 9 , 10 Family caregivers’ actions, including assisting with medical and nursing tasks, 11 are associated with health care utilization and outcomes, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 and effective clinician-caregiver communication is associated with reduced patient postdischarge resource use and decreased risk of unplanned readmission. 8 , 20 , 21 , 22 The Joint Commission has identified patient and family caregiver engagement as 1 of 7 foundations for safe and effective care transitions.…”