Health Disparities in Hospice-Home Health Transitions in Hispanic Older Adults With Co-occurring Dementia and Cardiovascular Disease.

Abstract

Purpose: In the US, nearly one-third of skilled home health (HH) patients and nearly one-half of hospice patients live with Alzheimer's disease and related dementias (ADRD). Hispanic older adults are more likely to live with ADRD than white non-Hispanic older adults. Persons with ADRD, compared to their counterparts without ADRD, have a prolonged trajectory of decline and experience multiple care transitions between health care settings, bringing risks for poor outcomes. Little is known about patients transitioning between skilled HH and hospice. We aimed to determine if there were demographic and/or diagnostic variables associated with the frequency of transitions between skilled HH and hospice.

Design: In a cross-sectional study, we used Medicare claims data from 2020 and descriptive statistics including Chi-Square to determine demographic and diagnostic differences in frequency of care transitions between skilled HH and hospice for older adults with ADRD.

Findings: In N = 272,323 hospice episodes, Hispanic older adult beneficiaries with ADRD and co-occurring cardiovascular disease (CVD) had significantly higher rates of care transitions from hospice to skilled HH (P = 0.037) than other racial and ethnic groups with both diagnoses.

Conclusions: Our findings provide evidence of disparities in care transitions from hospice to skilled HH for Hispanic older adults living with ADRD and CVD. Multiple factors may impact this result: Hospice low quality scores, insufficient advance care planning and understanding of hospice philosophy, and policies affecting eligibility. Implications include policy change and greater coordination of care for older adults with co-occurring ADRD and CVD, with attention to health equity.