Patterns of Care and Home Health Utilization for Community-Admitted Medicare Patients

A substantial proportion of growth in Medicare home health care over the past 15 years has been driven by patients who are admitted to home health care directly from the community, rather than from an acute care or post-acute care (PAC) setting. The purpose of this study was to develop a better understanding of the characteristics of community-admitted Medicare home health care patients, how these patients use care, and what their patterns of care tell us about the underlying reasons for their increased numbers. We also focused on understanding the role of home health as a substitute for long-term services and supports (LTSS). We used the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services DataLink file for our analyses. Our results show that there was large growth in community-admitted patient from 2002 to 2010, and much smaller growth from 2010 to 2013. We found that there are many important differences between patients based on the length of their home health care use, not just based on their source of admission, and that the source of admission may be a more important differentiator among patients who use home health care for longer periods. We also found that use of the home health care benefit is changing--use of home health aide care has declined and use of physical therapy services has increased, even for longer periods of care. Future research should focus on better understanding the increase in long-term home health care users.