Alzheimer Dementia: The heavier the cognitive function, the higher the cost of care

Elderly people with cognitive impairment-from mild cognitive impairment to Alzheimer's disease and related dementia (ADRD)-are a large number of users of healthcare, with a high burden of comorbidities and unique challenges Sexual care needs
.

Industry leaders and policymakers have turned their attention to developing targeted interventions to improve the quality and continuity of home and community care for people with cognitive impairments

Medicare-funded home health care (HHC) is a kind of welfare that provides skilled services in the patient's home environment, and is an important source of support for cognitively impaired elderly living in the community
.

Medicare beneficiaries with cognitive impairment are more likely to get HHC than beneficiaries without cognitive impairment, and one out of every three Medicare family care patients has a diagnosis of ADRD

diagnosis

However, previous work has not studied the difference in nursing intensity during HHC based on patients' cognitive impairment
.

During the medical insurance family health care period, patients may receive visits from different numbers of family health agency staff.

The type and intensity of visits received reflect the care needs of patients, drive variable costs, and are the main determinants of the profitability of family health care institutions
.

In view of the recent changes in payment policies, it is especially important to understand the intensity of care for HHC patients with cognitive impairment

However, the patient’s cognitive impairment is largely ignored, and reimbursement will only be affected when the patient is diagnosed with dementia and pressure ulcers or other specific skin conditions

To predict whether PDGM is likely to cause such unintended consequences, it is necessary to have information about the intensity of care of Medicare beneficiaries of cognitive impairment
.

The Center for Medicare and Medicaid Services (CMS) previously commissioned an analysis to provide information for the revision of the HHC case mix method.
The analysis showed that the patient’s cognitive impairment is related to a decrease in the intensity of care during HHC
.

However, the analysis did not adjust for the characteristics of any potentially confounding patients or providers, nor did it use econometric techniques to reduce endogenous bias

In this way, Julia G.
Burgdorf1 and others of Johns Hopkins University in the United States, based on the community life medical insurance beneficiaries who received HHC from 2011 to 2016, provided for the first time information about the cognitive impairment and nursing intensity of patients during HHC.
Information about the relationship
.

The results of the study provide a better understanding of the resources needed to care for this vulnerable subgroup, may guide future interventions to support home-based care in the context of cognitive decline, and may provide for future revisions to the medical insurance HHC payment system Information

This cohort study included a nationally representative sample of 1,214 Medicare HHC patients from 2011 to 2016
.

Multivariate logistic regression and negative binomial regression modeled the relationship between the patient’s CI and the intensity of care—measured by the number and type of interviews during the HHC period and the likelihood of receiving multiple consecutive HHC episodes

Multivariate logistic regression and negative binomial regression modeled the relationship between the patient’s CI and the intensity of care—measured by the number and type of interviews during the HHC period and the likelihood of receiving multiple consecutive HHC episodes

Patients with CI are 45% more likely to receive multiple consecutive HHC attacks (P <.
05),

The important significance of this study lies in the discovery: The recent changes in HHC reimbursement did not reflect the need for more intensive care of CI patients
.

The recent changes in HHC reimbursement do not reflect the need for more intensive care of CI patients
.

Original source:
Burgdorf JG, Amjad H, Bowles KH.
C ognitive impairment associated with greater care intensity during home health care.
Alzheimer's & Dementia.
Published online August 24, 2021:alz.
12438 .
Doi:10.
1002/alz.
12438

ognitive impairment associated with greater care intensity during home health care.
Alzheimer's & Dementia.
Published online August 24, 2021:alz.
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