Home Health Care and Place of Death in Medicare Beneficiaries With and Without Dementia

Background and Objectives: Home health care supports patient goals for aging in place. Our objective was to determine if home health care use in the last 3 years of life reduces the risk of inpatient death without hospice. Research Design and Methods: We analyzed the characteristics of 2,065,300 Medicare beneficiaries who died in 2019 and conducted multi¬nomial logistic regression analyses to evaluate the association between the use and timing of home health care, dementia diagnosis, and place of death. Results: Receiving any home health care in the last 3 years of life was associated with a lower probability of inpatient death without hospice (Pr 23.3% vs 31.5%, p < .001), and this effect was stronger when home health care began prior to versus during the last year of life (Pr 22.5% vs 24.3%, p < .001). Among all decedents, the probability of death at home with hospice compared to inpatient death with hospice was greater when any home health care was used (Pr 46.0% vs 36.5%, p < .001), and this association was strongest among beneficiaries with dementia who started home health care at least 1 year prior to death (Pr 55.6%, p < .001). Discussion and Implications: Use of home health care during the last 3 years of life was associated with reduced rates of inpatient death with¬out hospice, and increased rates of home death with hospice. Increasing affordable access to home health care can positively affect end-of-life care outcomes for older Americans and their family caregivers, especially those with dementia.