Abstract
OBJECTIVES: To investigate the relationship between unmet needs for family caregiver support, defined as lack of caregiver availability or capacity, and home health care (HH) service types delivered to patients with dementia. DESIGN: Cross-sectional study of national claims and assessment data. SETTING AND PARTICIPANTS: 325,148 older adults (aged ≥65 years) with diagnosed dementia receiving Medicare-funded HH in 2018. METHODS: Service types were measured from Medicare claims and refers to patient receipt of each of 6 service types covered during HH: nursing, physical therapy, occupational therapy, speech therapy, social work, and personal care aide. We fit multivariable logistic regression models estimating the odds of receiving each service type as a function of unmet caregiving needs and patient and HH agency characteristics, while clustering at the HH agency level. RESULTS: In adjusted models, lack of caregiver availability to help with medical, functional, or instrumental tasks was associated with higher odds of receiving skilled nursing [adjusted odds ratio (aOR) 1.63, 95% CI 1.47-1.81], aide (aOR 1.61, 95% CI 1.54-1.68), and social work (aOR 2.71, 95% CI 2.56-2.86), respectively. Lack of caregiver capacity to help with medical, functional, or instrumental tasks was associated with higher odds of receiving skilled nursing (aOR 1.29, 95% CI1.20-1.39), physical therapy (aOR 1.74, 95% CI1.68-1.81), and social work (aOR 1.24, 95% CI 1.17-1.28), respectively. CONCLUSIONS AND IMPLICATIONS: We observed significant associations between unmet needs for caregiving support and HH service delivery for patients with dementia. Expanding HH quality measurement and risk adjustment data elements to include measures of caregiver availability and capacity are necessary steps toward supporting HH providers' efforts to meet patients' needs regardless of their caregiving context.