Caregiving after discharge from the hospital

项目总结 在美国，照顾负担是一个巨大且日益令人担忧的问题。照看孩子的负担是平均的 当护理对象患有阿尔茨海默病或相关痴呆症(ADRD)时，效果会更好。老年人通常是 尤其是在入院后急性期需要援助。这种关怀经常 在住院患者急诊后护理环境中提供，如熟练护理设施(SNF)。近20%的 医院的出院费用流向了SNF，2015年医疗保险在急性后护理上花费了超过6000亿美元。其中 在痴呆症患者中，因急性后护理而出院到SNF的人数比例增加了一倍多 (48%)，与总税率相比。尽管在SNF上花费了大量资金，但急性后住院患者的价值 对病人的护理是不确定的。因此，减少其使用一直是付款人的共同目标，例如 医疗保险，特别是在将财务激励与改善价值和 降低医疗保健成本。其他支付模式，如捆绑支付计划，因此 导致急性期后SNF使用量下降。向直接出院更多病人的转变 然而，住院后回家可能会以照顾者和家庭为代价，特别是对于 痴呆症患者的家庭。这引发了人们对相关后果的极大担忧，包括 增加所需照料的数量(照料的频率和强度)和潜在的损失 由于这些护理需求的增加，工作效率下降。评估这种转变对以下方面的影响 照顾对于更全面地了解以家庭为基础的家庭成本的增加是必不可少的 急诊后护理。我们的总体目标是研究后急性时期护理工作的变化，特别是 在痴呆症患者中，由于住院后急性护理的使用率在付费方面有所下降 改革。我们将通过合并几个数据集(2011-2019年的调查和联邦医疗保险索赔)来实现这一点 载有关于急性后时期照护的详细信息。我们的具体目标是描述 急性期后照护的频率、强度和总量的趋势 护理接受者及其照顾者的特征；估计频率、强度和总的变化 与实施捆绑付款有关的急性后期间的照顾量 倡议；以及探索那些照顾家庭成员的人在工作效率方面的变化(见图 通过使用家庭病假)与捆绑支付实施相关联。这项研究的结果 将提供经验证据，说明使用SNF的减少如何影响后护理- 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.