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Who Provides Home-Based Primary Care to People With Dementia?
Monica O'Reilly-Jacob1, Madison Horton1, Xuefan Ji1
1Columbia University School of Nursing, New York, New York.
Journal of Gerontological Nursing
|March 25, 2026
Summary
Home-based primary care (HBPC) for dementia patients is expanding, with nurse practitioners (NPs) and physicians (MDs) providing services. Patients receiving care from both NPs and MDs exhibit greater medical and socioeconomic complexity.
Area of Science:
- Gerontology
- Health Services Research
- Primary Care
Background:
- Home-based primary care (HBPC) is increasingly crucial for managing dementia.
- Nurse practitioners (NPs) and physicians (MDs) are key providers in HBPC, often collaborating.
- Understanding patient characteristics across different provider models is essential for optimizing care.
Purpose of the Study:
- To compare patient characteristics among individuals with dementia receiving HBPC from NPs only, MDs only, or a combination of NPs and MDs.
- To analyze demographic and clinical differences based on HBPC provider composition.
Main Methods:
- A cross-sectional study utilizing 2019 Medicare claims data.
- Identification of dementia patients receiving HBPC.
- Bivariate statistical analysis to compare patient characteristics (age, dual-eligibility, race/ethnicity, comorbidities) across provider types.
Main Results:
- In 2019, 62,094 Medicare beneficiaries with dementia received HBPC.
- 40% received care from NPs exclusively, 33% from MDs exclusively, and 27% from both NPs and MDs.
- Patients receiving care from both NPs and MDs were more racially/ethnically diverse and had higher comorbidity burdens.
Conclusions:
- Nurse practitioners deliver a significant portion of HBPC to homebound individuals with dementia.
- Patients receiving collaborative care from both NPs and MDs present with greater medical and sociodemographic complexity.
- This highlights the need for tailored support and resources for complex patient populations within HBPC models.
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