Assisted living residents who receive services from home health agencies are more likely to have cognitive and activity of daily living impairments than people receiving home care in other settings, according to a study recently published in the journal Medical Care Research and Review.

Assisted living residents receiving home care also are less likely to have been discharged recently from an acute care setting compared with other home care recipients, according to the study authors, from Brown University. The finding suggests that assisted living residents are more likely to use home health to maintain their health rather than for post-acute care services, the researchers said. The finding also is consistent with the increasing acuity level and length of stay of residents in assisted living, they said.

“Because health insurers, such as Medicare, cover the costs of HHA [home health agency] services, AL operators may be increasingly receptive to contracting with third-party providers in order to assist residents in remaining in AL despite increasing impairment,” the authors wrote.

The study is among the first to examine the use of home health in assisted living communities, according to the researchers.

Additional findings, based on their examination of federal data:

  • Home health recipients living in assisted living communities generally are older than home health recipients in other settings, with 61.3% of the assisted living residents aged 85 years or older compared with 29.4% of other recipients.
  • Home health recipients in assisted living are more than twice as likely to exhibit cognitive impairments, particularly memory deficit and impaired decision-making, compared with recipients living in other settings (46.5% and 43.4% versus 15.2% and 19%, respectively).
  • A larger share of residents in assisted living receiving services from home health agencies experience memory deficits and impaired decision-making than cognitively impaired home health recipients living in other settings (89.8% versus 79.3% and 81.5% versus 74.2%, respectively).
  • Home health recipients in assisted living also are more likely to exhibit more ADL impairments than recipients in other settings, particularly with feeding (72.3% versus 59.1%), toileting transfer (83.5% versus 73.0%) and toileting hygiene (87.5% versus 78.3%).
  • Assisted living residents receiving home health agency services are more likely to be female, white and at least 85 years old compared with recipients of home health living in other settings.

Researchers found a slight increase in the share of home care being delivered in assisted living between 2012 and 2014. During that time, the share of home health agency services delivered in assisted living compared with other settings increased from 9.6% to 10.1%.

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