Home health is critical for older adults with Alzheimer’s Disease and Related Dementias (ADRD), and more therapy and/or nursing visits are linked to better home health outcomes. Yet, whether visit frequency varies by race and ethnicity remains unclear. Using Medicare claims data in 2019 and 2021, we analyzed a cohort of 301,916 fee-for-service hospitalized Medicare beneficiaries with ADRD, investigating differences in nursing and therapy visits within 30-day post-discharge across racial and ethnic groups, and changes during the COVID-19 pandemic. On average, patients received 5.1 nursing and 6.2 therapy visits pre-pandemic, declining to 4.6 and 5.2, respectively, in 2021. Black individuals experienced the most notable drop in nursing visits, while racially and ethnically minoritized groups consistently received fewer therapy visits compared to White counterparts, both before and during the pandemic. These results highlight persistent differences in home health utilization, with implications for policy promoting equitable access for minoritized populations.
CallahanC. M.ArlingG.TuW.RosenmanM. B.CounsellS. R.StumpT. E.HendrieH. C. (2012). Transitions in care for older adults with and without dementia. Journal of the American Geriatrics Society, 60(5), 813–820. https://doi.org/10.1111/j.1532-5415.2012.03905.x
2.
CallahanC. M.TuW.UnroeK. T.LaMantiaM. A.StumpT. E.ClarkD. O. (2015). Transitions in care in a nationally representative sample of older Americans with dementia. Journal of the American Geriatrics Society, 63(8), 1495–1502. https://doi.org/10.1111/jgs.13540
DavittJ. K.BourjollyJ.FrassoR. (2015). Understanding inequities in home health care outcomes: Staff views on agency and system factors. Research in Gerontological Nursing, 8(3), 119–129. https://doi.org/10.3928/19404921-20150219-01
8.
DemiralpB.SpeelmanJ. S.CookC. M.PierottiD.Steele-AdjognonM.HudakN.NeumanM. P.JulianoI.HarderS.KoenigL. (2021). Incomplete home health care referral after hospitalization among Medicare beneficiaries. Journal of the American Medical Directors Association, 22(5), 1022–1028. e1021. https://doi.org/10.1016/j.jamda.2020.11.039
9.
Fashaw-WaltersS. A.RahmanM.GeeG.MorV.WhiteM.ThomasK. S. (2022). Out of reach: Inequities in the use of high-quality home health agencies: Study examines inequities in the use of high-quality home health agencies. Health Affairs, 41(2), 247–255. https://doi.org/10.1377/hlthaff.2021.01408
10.
Harris-KojetinL.SenguptaM.LendonJ. P.RomeV.ValverdeR.CaffreyC. (2019). Long-term care providers and services users in the United States, 2015–2016. National Center for Health Statistics. Vital Health Stat, 3(43), 1–78.
11.
JarrínO. F.NyandegeA. N.GrafovaI. B.DongX.LinH. (2020). Validity of race and ethnicity codes in Medicare administrative data compared with gold-standard self-reported race collected during routine home health care visits. Medical care, 58(1), e1–e8. https://doi.org/10.1097/MLR.0000000000001216
12.
KnoxS.DownerB.HaasA.OttenbacherK. J. (2022). Home health utilization association with discharge to community for people with dementia. Alzheimer's & Dementia (New York, N. Y.), 8(1), Article e12341. https://doi.org/10.1002/trc2.12341
13.
LeDouxC. V.LindroothR. C.SeidlerK. J.FalveyJ. R.Stevens‐LapsleyJ. E. (2020). The impact of home health physical therapy on Medicare beneficiaries with a primary diagnosis of dementia. Journal of the American Geriatrics Society, 68(4), 867–871. https://doi.org/10.1111/jgs.16307
14.
LiJ.QiM.WernerR. M. (2020). Assessment of receipt of the first home health care visit after hospital discharge among older adults. JAMA Network Open, 3(9), Article e2015470. https://doi.org/10.1001/jamanetworkopen.2020.15470
15.
LoomerL.KosarC. M.MeyersD. J.ThomasK. S. (2021). Comparing receipt of prescribed post-acute home health care between Medicare advantage and traditional Medicare beneficiaries: An observational study. Journal of General Internal Medicine, 36(8), 2323–2331. https://doi.org/10.1007/s11606-020-06282-3
MrozT. M.MeadowA.ColantuoniE.LeffB.WolffJ. L. (2018). Home health agency characteristics and quality outcomes for Medicare beneficiaries with rehabilitation-sensitive conditions. Archives of Physical Medicine and Rehabilitation, 99(6), 1090–1098. e1094. https://doi.org/10.1016/j.apmr.2017.08.483
18.
NarayanM. C.ScafideK. N. (2017). Systematic review of racial/ethnic outcome disparities in home health care. Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society, 28(6), 598–607. https://doi.org/10.1177/1043659617700710
19.
NavatheA. S.GrabowskiD. C. (2020). Will Medicare’s new patient-driven postacute care payment system be a step forward?JAMA Health Forum, 1(6), Article e200718. https://doi.org/10.1001/jamahealthforum.2020.0718
20.
NikmatA. W.HawthorneG.Al-MashoorS. H. (2015). The comparison of quality of life among people with mild dementia in nursing home and home care—a preliminary report. Dementia, 14(1), 114–125. https://doi.org/10.1177/1471301213494509
21.
O'ConnorM.HanlonA.NaylorM. D.BowlesK. H. (2015). The impact of home health length of stay and number of skilled nursing visits on hospitalization among Medicare‐reimbursed skilled home health beneficiaries. Research in Nursing & Health, 38(4), 257–267. https://doi.org/10.1002/nur.21665
22.
PickensS.NaikA. D.CaticA.KunikM. E. (2018). Dementia and hospital readmission rates: A systematic review. Dementia and Geriatric Cognitive Disorders Extra, 7(3), 346–353. https://doi.org/10.1159/000481502
23.
ShangJ.ChastainA. M.PereraU. G. E.QuigleyD. D.FuC. J.DickA. W.Pogorzelska-MaziarzM.StoneP. W. (2020). COVID-19 preparedness in US home health care agencies. Journal of the American Medical Directors Association, 21(7), 924–927. https://doi.org/10.1016/j.jamda.2020.06.002
24.
SmithJ. M.JarrínO. F.LinH.TsuiJ.DharamdasaniT.Thomas-HawkinsC. (2021). Racial disparities in post-acute home health care referral and utilization among older adults with diabetes. International Journal of Environmental Research and Public Health, 18(6), 3196. https://doi.org/10.3390/ijerph18063196
25.
SonG. R.TherrienB.WhallA. (2004). Implicit memory and familiarity among elders with dementia. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 34(3), 263–267. https://doi.org/10.1111/j.1547-5069.2002.00263.x
26.
Temkin-GreenerH.YanD.CaiS. (2023). Post-acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status. Health Services Research, 58(1), 164–173. https://doi.org/10.1111/1475-6773.14059
TylerD. A.SquillaceM. R.PorterK. A.HunterM.HaltermannW. (2022). COVID-19 exacerbated long-standing challenges for the home care workforce. Journal of Aging & Social Policy, 36(6), 1510–1528. https://doi.org/10.1080/08959420.2022.2136919
VergezS. M.BarrónY.McDonaldM. V. (2025). Disparities in timely receipt of home healthcare: Neighborhood disadvantage and delayed start-of-care visits in New York City. Journal of the American Geriatrics Society, 73(5), 1462–1471. https://doi.org/10.1111/jgs.19406
32.
WangJ.CaprioT. V.SimningA.ShangJ.ConwellY.YuF.LiY. (2020). Association between home health services and facility admission in older adults with and without Alzheimer's disease. Journal of the American Medical Directors Association, 21(5), 627–633.e9. https://doi.org/10.1016/j.jamda.2019.11.002
33.
WernerR. M.BressmanE. (2021). Trends in post-acute care utilization during the COVID-19 pandemic. Journal of the American Medical Directors Association, 22(12), 2496–2499. https://doi.org/10.1016/j.jamda.2021.09.001
34.
WernerR. M.KonetzkaR. T. (2018). Trends in post–acute care use among Medicare beneficiaries: 2000 to 2015. JAMA, 319(15), 1616–1617. https://doi.org/10.1001/jama.2018.2408
35.
YangM.-T.Temkin-GreenerH.VeazieP.CaiS. (2024a). Home health quality among hospitalized older adults with Alzheimer's disease and related dementia: Association with race/ethnicity and dual eligibility before and during the COVID pandemic. Journal of the American Medical Directors Association, 25(8), Article 105057. https://doi.org/10.1016/j.jamda.2024.105057
36.
YangM. T.Temkin‐GreenerH.VeazieP.CaiS. (2024b). Post‐acute care transitions during COVID‐19: Racial, ethnic, and socioeconomic differences in older adults with Alzheimer’s disease and related dementia. Journal of the American Geriatrics Society, 72(7), 2006–2016. https://doi.org/10.1111/jgs.18884
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
