Beneficiary Characteristics Associated With Volume of Skilled Clinical Nursing and Therapy Home Health

Medicare home health is a critical source of skilled clinical care for homebound adults, but home health provision has declined since 2020. By identifying beneficiaries' characteristics associated with home health visit utilization in prior years, we sought to explore the implications of recent service reductions.

Retrospective, secondary analysis of home health utilization using National Health and Aging Trends Study survey responses linked to Medicare home health claims files.

One thousand four hundred sixty-five Medicare beneficiaries who responded to the National Health and Aging Trends Study and received home health between 2011 and 2015.

Predictors of total nurse/therapist visits were assessed using negative binomial regressions. We measured the volume of home health as the number of annual visits by nurses (registered and licensed practical/vocational nurses) and by therapists (physical, occupational, and speech therapists). Predictors included beneficiaries' sociodemographic, functional, and health-related characteristics.

Beneficiaries were 62.8% female, 80.2% White, and the mean age was 80. On average, beneficiaries received 15.9 nurse visits annually. Nurse visits comprised approximately half of all home health visits. Predictors of increased nurse visits included being unmarried (+7.0 visits), widowed (+4.8 visits), Medicaid enrollment (+5.2 visits), and dependence on others to manage medications (+5.6 visits). On average, beneficiaries received 9.8 therapist visits annually, comprising about a third of all home health visits. Predictors of additional therapist visits included instrumental activities of daily living disability (+3.7 visits), chronic illness multicomorbidity (+2.9 visits), and medication management needs (+2.8 visits).

Clinical complexity, disability, and social vulnerabilities were associated with greater volumes of skilled home health provision from nurses and therapists from 2011 to 2015. Our results highlight care needs that may be underaddressed and inequities that may be exacerbated under current home health provisions.