Dementia Severity Associated With Unmet Caregiving Needs During Skilled Home Health Care

One-third of home health care (HHC) patients have dementia. Despite the critical role of caregivers for this population, little is known regarding prevalence or risk factors for unmet caregiving needs during HHC. We examined 426,608 older (65+) HHC patients with dementia in 2018. Unmet caregiving needs were determined from HHC clinician reports indicating that (1) no caregiver was present (lack of availability) or (2) the caregiver needed training (lack of capacity). Most (83%) HHC patients with dementia experienced an unmet need for caregiving. Medicaid enrollment and depression were associated with lack of caregiver availability; greater clinical severity and being post-acute were associated with lack of caregiver capacity. Patients with high (compared to low) cognitive symptom severity had higher odds of unmet needs due to lack of caregiver capacity (aOR:1.80; 95% CI: 1.70-1.90). Findings illustrate the gap between dementia caregiving needs and capacity, highlighting the importance of supportive resources such as training.