Sharp Declines in Home Health for Patients with Dementia

Dementia ranks as a leading cause of disability for elderly patients, and the prevalence is expected to quadruple over the next three decades.¹ The cognitive decline and accelerated physical decline associated with dementia erode patient safety and independence, increase healthcare costs, and reduce the wellbeing of family caregivers.^1-4 On the other hand, studies show that elderly patients with dementia who live at home can improve verbal communication, cognition, behavior, and independence with activities of daily living.⁵ What’s more, despite the challenges presented by dementia, research shows that in-home rehab reduces fall risk an average of 32% and reverses even long-standing disability.^6,7 In addition to direct patient care and rehabilitation, home health care plans for dementia often include caregiver training. That caregiver training is associated with strong gains in caregiver well-being as well as important gains in patient independence with daily activities, cognitive ability, and mood. All of these interventions and benefits are available through home health, with Medicare paying 100%.

Corresponding with rising prevalence and an increasing awareness of the benefits of home health, among patients with dementia, utilization of home health rose steadily from 2010 to 2020. Per 1,000 beneficiaries with dementia per year, home health utilization, stemming from community-based referrals, went from 35 to 40 (a 17% increase). For home health referrals from inpatient facilities, utilization rose 21% (29 to 35).⁹ In May, the Journal of the American Medical Association published a study showing an alarming drop in home health for patients with dementia.⁹ The drop started in 2020, saw a sharp rebound in the second half of 2020, but then declined steadily over the next 24 months. By the end of 2022, all gains in utilization from 2011 forward had been wiped out. By comparison, home health utilization for people without dementia has been steadily declining since 2010, and there was no sharp decline in 2021 and 2022 as we saw in dementia.

It is unclear why fewer patients with dementia are receiving home health, when home health proves to be such a strong benefit for this patient population. Ideal Home Care, for one, stands ready to accept referrals for all your homebound patients with skilled need, including patients with dementia. To qualify, patients should have a recent medical occurrence such as a new diagnosis of dementia, a change in the stage of dementia, new medications where nurse teaching may be helpful, a possibility of medication non-adherence, newly documented declines, an accidental fall, etc. A higher percentage of home health referrals for patients with dementia occur without a recent inpatient stay, but referrals both with and without an inpatient stay are common.   

If a dementia patient is homebound with skilled need, refer early. Ideal can often start care quickly and support caregiver training. One call or fax starts the process. Our team confirms eligibility and coordinates orders.

Remember to Bill for Home Health Certifications

Among the seven different billing codes doctors could use for reimbursement for work done with Ideal Home Care, certification and recertification of home health plans of care is probably the easiest to bill. The documentation requirements for these codes are nothing more than saving the paperwork you are reviewing.

G0180 = Initial Certification of Medicare Home Health Care

*Payment comparable to a routine office visit

G0179 = Recertification of Medicare Home Health Care

*Pays more than common paperwork codes

Please offer Ideal Home Care to Your Patients.

References

1. Marsh N, Larsen E, Tapp S, Sommerville M, Mihala G, Rickard CM. Management of hospital in the home (HITH) peripherally inserted central catheters: a retrospective cohort study. Home Health Care Management & Practice. 2020 Feb;32(1):34-9.
2. Huang X, Shi K, Zain NM, Yusuf A. Home care-based education for cancer patients with peripherally inserted central catheters: a systematic review and meta-analysis. Supportive Care in Cancer. 2025 Jul;33(7):1-23.