Caregiving after discharge from the hospital

项目摘要 在美国，照顾负担是一个越来越大的问题。负担的负担是均匀的 当护理接受者患有阿尔茨海默病或相关痴呆症（ADRD）时，这种情况更严重。老年人往往 特别是住院后、急性期期间需要帮助。这种关怀常常 在住院急性期后护理环境中提供，如熟练护理机构（SNF）。接近20%的 2015年，医院的出院费用由SNF支付，医疗保险在急性期后护理上花费了超过6000亿美元。之间 在痴呆症患者中，出院到SNF接受急性后护理的人的比例增加了一倍多 (48%），与整体比率相比。尽管在SNF上花费了大量资金， 对病人的照顾是不确定的。因此，减少其使用一直是付款人的共同目标， 医疗保险，特别是在替代支付模式下，将财务激励与提高价值和 降低医疗保健的成本。因此，替代支付模式，如捆绑支付计划， 导致急性期后SNF的使用减少。向直接让更多病人出院的转变 住院后回家可能会以照顾者和家庭为代价，然而，特别是对于 痴呆症患者的家庭。这引起了对相关后果的严重关切，包括 增加的所需重复次数（重复次数和重复强度）和潜在损失 由于这些不断增加的需求，工作生产率。评估这一转变对 为了更全面地了解家庭暴力增加的全部成本， 急性期后护理我们的总体目标是研究急性期后的心脏病变化，特别是 在痴呆症患者中，由于在支付费用的情况下， 改革。我们将通过结合几个数据集（2011-2019年的调查和医疗保险索赔）来做到这一点， 包含急性期后的详细信息。我们的具体目标是描述 在急性期后和急性期内， 护理接受者及其照顾者的特征;估计频率，强度和总的变化 与实施捆绑支付相关的急性期后的费用金额 以及探讨照顾家庭成员的人的工作生产力的变化（ 通过使用家庭病假）与捆绑付款的实施相关联。本研究的结果 将提供经验证据，说明SNF使用的减少如何影响后 急性期

PROJECT SUMMARY Caregiving burden is a large and growing concern in the United States. The burden of caregiving is even greater when the care recipient has Alzheimer's disease or related dementias (ADRD). Older adults are often in particular need of assistance after hospitalization, during the post-acute period. This care has frequently been provided in inpatient post-acute care settings, such as skilled nursing facilities (SNFs). Close to 20% of hospital discharges go to a SNF and Medicare spent over $600 billion on post-acute care in 2015. Among persons with dementia, the percentage of people discharged to SNFs for post-acute care is more than double (48%), compared to the overall rate. Despite the large spending on SNFs, the value of inpatient post-acute care to patients is uncertain. As a result, reducing its use has been a common target for payers such as Medicare, particularly under alternative payment models that tie financial incentives to improving value and reducing the costs of health care. Alternative payment models, such as bundled payment initiatives, have thus resulted in a declining use of SNFs in the post-acute period. The shift toward discharging more patients directly home after hospitalization may come at the expense of caregivers and families, however, particularly for families of persons with dementia. This raises substantial concern about associated consequences, including the increased amount of needed caregiving (both the frequency and intensity of caregiving) and potential loss of work productivity due to these increased caregiving demands. Evaluating the impact of this shift on caregiving is essential to gain a more complete understanding of the full costs of the increase in home-based post-acute care. Our overall objective is to examine changes in caregiving in the post-acute period, particularly among persons with dementia, as the use of inpatient post-acute care declines in the context of payment reform. We will do so by combining several datasets (surveys and Medicare claims from 2011-2019) that contain detailed information on caregiving during the post-acute period. Our specific aims are to describe trends in the frequency, intensity, and total amount of caregiving in the post-acute period and the characteristics of care recipients and their caregivers; to estimate changes in the frequency, intensity, and total amount of caregiving during the post-acute period associated with implementation of bundled payment initiatives; and to explore changes in work productivity among those who care for a family member (captured via use of family medical leave) associated with bundled payment implementation. The results from this study will provide empirical evidence regarding how the declining use of SNF has impacted caregiving in the post- acute period.