Changes in Medicare's Chronic Condition Files and Disparities in Dementia Identification.

Objectives: In 2017, the Chronic Condition Warehouse released a 30-condition Chronic Condition file (CC30), which fully replaced the prior 27-condition file (CC27) in 2022. CC30 shortened the look-back period for dementia identification from 3 to 2 years and raised the required outpatient/carrier claims from 1 to 2. This change may disproportionately affect individuals with limited access to health care.

Racial and Ethnic Differences in Post-acute Home Health Services Among Older Adults With Alzheimer's Disease and Related Dementias.

Home health is critical for older adults with Alzheimer's Disease and Related Dementias (ADRD), and more therapy and/or nursing visits are linked to better home health outcomes. Yet, whether visit frequency varies by race and ethnicity remains unclear. Using Medicare claims data in 2019 and 2021, we analyzed a cohort of 301,916 fee-for-service hospitalized Medicare beneficiaries with ADRD, investigating differences in nursing and therapy visits within 30-day post-discharge across racial and ethnic groups, and changes during the COVID-19 pandemic.

Ambulatory Care Sensitive Hospitalizations and Disparities Among Older Adults With Dementia Before and During the Pandemic.

Background: Older adults with Alzheimer's disease and related dementias (ADRD) are frequently hospitalized with ambulatory care-sensitive conditions (ACSCs). Disparities in ACSC hospitalizations have been documented, but the impact of the COVID-19 pandemic on ACSC hospitalizations and disparities of older adults with ADRD is unclear, particularly, across different racial, ethnic, and socioeconomic groups. This study examined changes in ACSC hospitalizations among community-dwelling older adults with ADRD before and during the pandemic and how these changes vary by race, ethnicity, and Medicare-Medicaid dual eligibility status.

Hospice Visits and Perceived Hospice Quality Among Assisted Living Residents.

Background: Hospice services are widely used by assisted living residents at the end of life, yet concerns exist about the adequacy and quality of hospice care in this setting.

Participants And Setting: This cohort study analyzed Medicare claims data from 51,303 assisted living residents who received hospice care and died in 2018-2019. Data were linked to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey to evaluate perceived hospice quality.

Urinary Incontinence Is an Independent Risk Factor for Nursing Home Placement among Assisted Living Residents.

Objectives: Prior studies suggested that urinary incontinence (UI) may be a risk factor for nursing home (NH) placement among older community-dwelling individuals. Our objectives were to evaluate if UI is an independent risk factor in NH placement among assisted living (AL) residents and assess the impact of UI on NH placement by race/ethnicity.

Design: This retrospective cohort study is based on the 2019-2021 Medicare enrollment and claims data.

Long-Stay Nursing Home Residents with Dementia: Telemedicine Mental Health Use during the COVID-19 Pandemic.

Objective: To examine racial and ethnic differences in telemedicine mental health (tele-MH) use among nursing home (NH) long-stay residents with Alzheimer's disease and related dementias (ADRD) during the pandemic.

Design: Observational study.

Setting And Participants: The 2020-2021 Minimum Data Set 3.

Disparities in COVID-19-Related Mortality Among Older Adults With Alzheimer's Disease and Related Dementias: Variations Over Time.

Older adults with Alzheimer's disease and related dementias (ADRD) had a high risk of COVID-19-related mortality. Racial and ethnic minorities were disproportionally impacted by the pandemic. The variations in disparities, including racial and ethnic disparities and disparities across communities, in COVID-19-related mortality across the different stages of the COVID-19 pandemic among the ADRD population are unknown.

Telemedicine Utilization Among Residents With Alzheimer Disease and Related Dementia: Association With Nursing Home Characteristics.

Objective: To examine telemedicine use among nursing home (NH) residents with Alzheimer disease and related dementias (ADRD) and the associations with NH characteristics.

Design: Observational study.

Setting And Participants: 2020-2021 Minimum Data Set 3.

Home Health Quality among Hospitalized Older Adults with Alzheimer's Disease and Related Dementia: Association with Race/Ethnicity and Dual Eligibility before and during the COVID Pandemic.

Objectives: During the COVID-19 pandemic, home health agencies (HHAs) discharges following acute hospitalizations increased. This study examined whether racial and ethnic minoritized and socioeconomically disadvantaged patients (ie, Medicare-Medicaid dual-eligible) were differentially discharged to below-average quality HHAs before and during the COVID-19 pandemic. We focused on post-acute patients with Alzheimer's disease and related dementias (ADRD), who are generally frail and have high care needs.

Racial and ethnic differences in telemedicine use among community-dwelling older adults with dementia.

Background: Routine ambulatory care is essential for older adults with Alzheimer's disease and related dementias (ADRD) to manage their health conditions. The federal government expanded telemedicine coverage to mitigate the impact of the COVID-19 pandemic on ambulatory services, which may provide an opportunity to improve access to care. This study aims to examine differences in telemedicine use for ambulatory services by race, ethnicity, and community-level socioeconomic status among community-dwelling older adults with ADRD.

Telemedicine and Disparities in Mental Health Service Use Among Community-Dwelling Older Adults With Alzheimer Disease and Related Dementias.

Objective: To examine disparities in mental health (MH) service utilization, via in-person and telemedicine (ie, tele-MH), by individuals' race, ethnicity, and community socioeconomic status, among community-dwelling older adults with Alzheimer disease and related dementias (ADRD) before and after the expansion of the Centers for Medicare and Medicaid Services' (CMS's) telemedicine policy.

Design: Observational study.

Setting And Participants: A total of 3,003,571 community-dwelling Medicare beneficiaries with ADRD between 2019 and 2021 were included in the study.

Assisted living residents with dementia: Disparities in mental health services pre and during COVID-19.

Background: Little is known about mental health among Medicare beneficiaries with Alzheimer's disease or related dementias (ADRD) who reside in assisted living (AL) communities. The COVID-19 pandemic may have curtailed ambulatory care access for these residents, but telehealth may have expanded it. We examined in-person and telehealth use of ambulatory mental health visits among AL residents with ADRD, pre and during the COVID pandemic, focusing on race/ethnicity and Medicare/Medicaid dual status.

Outcomes After Community Discharge From Skilled Nursing Facilities: The Role of Medicaid Home and Community-Based Services.

This study investigated the association between Medicaid Home and Community-Based Services (HCBS) generosity and post-discharge outcomes among dual-eligible beneficiaries discharged from skilled nursing facilities (SNFs). We linked multiple national datasets for duals discharged from SNFs between 2010 and 2013. Accounting for SNF fixed effects, we estimated the effect of HCBS generosity, measured by its breadth and intensity, on the likelihood of remaining in the community, risks of death, nursing home (NH) admission, and hospitalizations within 30 and 180 days after SNF discharge.

Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement.

Objectives: Assess prevalence of serious mental illness (SMI) alone, and co-occurring with Alzheimer disease and related dementias (ADRD), among Medicare beneficiaries in assisted living (AL). Examine the association between permanent nursing home (NH) placement and SMI, among residents with and without ADRD.

Design: 2018-2019 retrospective cohort of Medicare beneficiaries in AL.

Hospice providers serving assisted living residents: Association of higher volume with lower quality.

Background: Assisted living (AL) community caregivers are known to report lower quality of hospice care. However, little is known about hospice providers serving AL residents and factors that may contribute to, and explain, differences in quality. We examined the association between hospice providers' AL patient-day volume and their quality ratings based on Hospice Item Set (HIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Surveys.

Post-acute care transitions during COVID-19: Racial, ethnic, and socioeconomic differences in older adults with Alzheimer's disease and related dementia.

Background: Differences in the post-acute care (PAC) destinations among racial, ethnic, and socioeconomic groups have been documented before the COVID-19 pandemic. Yet, the pandemic's impact on these differences remains unknown. We examined the impact of the COVID-19 pandemic on PAC destinations and its variation by individual race, ethnicity, and socioeconomic status among community-dwelling older adults with Alzheimer's disease and related dementia (ADRD).

Home time and state regulations among Medicare beneficiaries in assisted living communities.

Background: Home time is an important patient-centric quality metric, which has been largely unexamined among assisted living (AL) residents. Our objectives were to assess variation in home time among AL residents in the year following admission and to examine the associations with state regulations for direct care workers (DCW) training and staffing and for licensed nurse staffing.

Methods: Medicare beneficiaries who entered AL communities in 2018 were identified, and their home time in the year following admission was measured.

Did Minimum Wage Policy Changes Impact Home Health Workforce?

The shortage of home health aides has been exacerbated in recent years partially because of low wages. Minimum wage (MW) policy changes may alleviate this workforce shortage. This study examined the effects of MW policies on wages and employment of home health aides.

Assisted living or nursing home: Who is moving in?

Background: Despite the rapid growth of assisted living (AL) communities and the increasing similarity between AL and nursing home (NH) populations, little is known about the characteristics of older adults at the time of AL admission and how these characteristics compare to individuals newly admitted to NH from the community. This study examined the individual, facility, and geographic factors associated with new AL admission.

Methods: This retrospective descriptive study used data from the national Medicare enrollment and claims datasets, the Minimum Data Set, and the Medicare Provider Analysis and Review.

Hospital Proximity and Emergency Department Use among Assisted Living Residents.

Objectives: To examine the relationship between AL communities' distance to the nearest hospital and residents' rates of emergency department (ED) use. We hypothesize that when access to an ED is more convenient, as measured by a shorter distance, assisted living (AL)-to-ED transfers are more common, particularly for nonemergent conditions.

Design: Retrospective cohort study, where the main exposure of interest was the distance between each AL and the nearest hospital.

Racial/Ethnic Differences in Risk Factors Associated With Severe COVID-19 Among Older Adults With ADRD.

Objective: To examine racial/ethnic differences in risk factors, and their associations with COVID-19-related outcomes among older adults with Alzheimer's disease and related dementias (ADRD).

Design: Observational study.

Setting And Participants: National Medicare claims data and the Minimum Data Set 3.

Online Customer Reviews of Assisted Living Communities: Association with Community, County, and State Factors.

Objectives: Online reviews provided by users of assisted living communities may offer a unique source of heretofore unexamined data. We explored online reviews as a possible source of information about these communities and examined the association between the reviews and aspects of state regulations, while controlling for assisted living, county, and state market-level factors.

Design: Cross-sectional, observational study.

End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations.

Objective: We examined the frequency and categories of end-of-life care transitions among assisted living community decedents and their associations with state staffing and training regulations.

Design: Cohort study.

Setting And Participants: Medicare beneficiaries who resided in assisted living facilities and had validated death dates in 2018-2019 (N = 113,662).