Effects of Family Caregiver Availability and Capacity on Home Health Care for Older Adults with Alzheimer's Disease and Related Dementias

项目摘要/摘要 据估计，中国有540万患有阿尔茨海默病和相关痴呆(ADRD)的老年人 在美国，67%的人居住在有独特和重要护理需求的社区。医疗保险资助的家庭健康(HH) 在患者家中提供熟练的护理、治疗和个人护理辅助服务，是为数不多的 为ADRD患者提供负担得起的、可获得的居家护理选择。在340万人的医疗保险中 每年使用HH的受益者中，有31%患有ADRD。患有ADRD的HH患者接受更严格的治疗 然而，更有可能出现包括住院和住院在内的不良后果。 因此，迫切需要开发量身定制的HH干预措施，以改善ADRD患者的预后。 在87%的HH发作中，临床医生报告需要家庭照顾者的帮助来实施护理计划 在HH期间与家庭照顾者接触/支持有助于改善护理结果-包括 降低再入院风险，提高患者和家属的满意度。家庭照顾者是一项重要的资源 对于患有ADRD的人，包括在HH期间。然而，目前关于ADRD的信息很少 家庭照顾者在HH期间的特定角色和支持需求。老年人对ADRD照顾者参与情况分析 护理服务的提供侧重于门诊环境，由于这种环境的原因，对HH的适用性有限 独特的支付和护理交付结构。检查照顾者活动和培训需求的前期工作 在HH期间，没有专门检查那些患有ADRD的人。患有ADRD的HH患者(和他们的照顾者)优点 给出的有针对性的研究：ADRD护理的独特挑战，ADRD患者患不良HH的风险更高 结果，以及先前的工作表明，照顾者在HH期间更有可能需要培训，如果帮助 有认知障碍的患者。 该项目的目标是描述ADRD照顾者在HH期间的角色和培训需求，并确定 护理者的可获得性和能力如何影响ADRD患者的HH护理交付和预后。 可用性指的是照顾者愿意提供帮助的意愿，以及他们在家中出现的频率。容量 指照顾者确定的与特定照看活动相关的培训需求。我们将使用一个国家 年接受HH的诊断为ADRD(通过Medicare Claims确定)的Medicare受益人样本 2018年。我们将分析相关联的HH患者评估、Medicare索赔和HH机构管理数据，以 此样本用于1)描述护理者的参与程度(包括提供的援助类型、可用性和 能力)；2)确定护理者的可用性和能力对卫生保健服务交付的影响 ADRD患者；以及3)评估照顾者的可用性和能力对HH结局的影响 ADRD患者。研究结果将为ADRD照顾者的角色和 HH期间的支持需求，为制定有针对性的干预措施以改善HH患者的护理提供信息 通过更好地参与和支持他们的家庭照顾者，与ADRD合作。

PROJECT SUMMARY/ABSTRACT Of an estimated 5.4 million older adults with Alzheimer’s Disease and Related Dementias (ADRD) in the US, 67% reside in the community with unique and significant care needs. Medicare-funded Home Health (HH) delivers skilled nursing, therapy, and personal care aide services in the patient’s home and is one of few affordable and accessible options for home-based care among those with ADRD. Of the 3.4 million Medicare beneficiaries who access HH each year, 31% have ADRD. HH patients with ADRD receive more intensive care, yet are more likely to experience adverse outcomes including institutionalization and hospitalization. Thus, there is critical need to develop tailored HH interventions to improve outcomes for patients with ADRD. In 87% of HH episodes, clinicians report needing family caregiver assistance to implement the plan of care and engaging/supporting family caregivers during HH contributes to improved care outcomes—including reduced readmission risk and greater patient and family satisfaction. Family caregivers are a crucial resource for those with ADRD, including during HH. However, there is currently a dearth of information regarding ADRD family caregivers’ specific roles and support needs during HH. Analyses of ADRD caregiver involvement in care delivery have focused on the ambulatory setting and hold limited applicability for HH due to this setting’s unique payment and care delivery structures. Prior work examining caregiver activities and training needs during HH did not specifically examine those with ADRD. HH patients with ADRD (and their caregivers) merit targeted study given: the unique challenges of ADRD caregiving, ADRD patients’ higher risk for adverse HH outcomes, and prior work indicating that caregivers are more likely to need training during HH if assisting a patient with cognitive impairment. The goal of this project is to describe ADRD caregivers’ role and training needs during HH, and to determine how caregiver availability and capacity impact HH care delivery and outcomes for patients with ADRD. Availability refers to caregivers’ willingness to assist and how often they are present in the home. Capacity refers to caregivers’ identified training needs related to specific caregiving activities. We will use a national sample of Medicare beneficiaries with diagnosed ADRD (determined via Medicare claims) who received HH in 2018. We will analyze linked HH patient assessment, Medicare claims, and HH agency administrative data for this sample to 1) characterize caregiver involvement (including types of assistance provided, availability, and capacity) during HH; 2) determine the impact of caregiver availability and capacity on HH care delivery for patients with ADRD; and 3) assess the impact of caregiver availability and capacity on HH outcomes for patients with ADRD. Findings will provide novel foundational evidence regarding ADRD caregivers’ role and support needs during HH, informing the development of targeted interventions to improve care for HH patients with ADRD by better engaging and supporting their family caregivers.