Meeting News

After ICU discharge, many Medicare beneficiaries do not receive home rehabilitation care

A third of Medicare beneficiaries did not receive home health rehabilitation after being discharged from the intensive care unit, according to research presented at the Society of Critical Care Medicine’s Critical Care Congress.

“Disability in walking, bathing, swallowing and speaking are common in older adults after being in the ICU and at a minimum, patients who are discharged and are homebound should be evaluated by physical, occupational and speech therapists,” Jason Falvey, DPT, PhD, a post-doctoral fellow at Yale School of Medicine, said in a press release.

“Our findings are concerning because it typically takes 3 to 6 months for older ICU survivors to recover function, and home rehabilitation can really help in that regard,” he continued.

Falvey and colleagues assessed Medicare claims for hospitalization and home health rehabilitation services — including physical, speech and occupational therapy — in 2012. They used the Medicare Outcomes and Information Set (OASIS) to link information from patients to each claim and the Medicare Master Beneficiary System File to collect demographic data.

Photo of older woman receiving home care 
A third of Medicare beneficiaries did not receive home health rehabilitation after being discharged from the intensive care unit, according to research presented at the Society of Critical Care Medicine’s Critical Care Congress.
Source: Adobe Stock

The analysis included 3,176 patients who stayed in the ICU for at least 24 hours during their hospitalization for a critical illness before being discharged. They received a median of 3.5 home rehabilitation visits within 30 days of discharge.

Falvey and colleagues found that 33% of patients did not receive a single visit in the 30 days after discharge.

Rehabilitation visits were more common among patients who were older (RR = 1.03; 95% CI, 1.01-1.04 per 5 years), had higher OASIS disability measure scores (RR = 1.03; 95% CI, 1.02-1.04 per point) and severe dyspnea (RR = 1.12; 95% CI, 1.04-1.21), according to the researchers.

In contrast, characteristics associated with fewer home health rehabilitation visits included having a higher comorbidity count (RR = 0.98; 95% CI, 0.96-0.99), living in rural regions (RR = 0.87; 95% CI, 0.81-0.97) and living alone (RR = 0.88; 95% CI, 0.81-0.96).

Although the researchers were not surprised that patients living in rural areas had fewer home health rehabilitation visits, Falvey said in the release that they were surprised to find that living alone was associated with fewer visits.

“It might be that those who lived alone were healthier and higher functioning or that they were perceived that way, so they weren’t provided referrals to home rehabilitation,” he added.

In the release, Falvey also noted that clinicians should be aware that patients living alone or in rural areas could be exposed to more post-discharge care disparities, and to ensure these patients receive the care they need to regain their mobility when they return home. – by Erin Michael

Reference:

Falvey J, et al. CT-55. Presented at: Society of Critical Care Medicine’s Critical Care Congress; Feb. 16-19, 2020; Orlando.

Disclosures: Falvey reports receiving royalties from MedBridge for a course related to hospital readmissions for rehabilitation professionals.

A third of Medicare beneficiaries did not receive home health rehabilitation after being discharged from the intensive care unit, according to research presented at the Society of Critical Care Medicine’s Critical Care Congress.

“Disability in walking, bathing, swallowing and speaking are common in older adults after being in the ICU and at a minimum, patients who are discharged and are homebound should be evaluated by physical, occupational and speech therapists,” Jason Falvey, DPT, PhD, a post-doctoral fellow at Yale School of Medicine, said in a press release.

“Our findings are concerning because it typically takes 3 to 6 months for older ICU survivors to recover function, and home rehabilitation can really help in that regard,” he continued.

Falvey and colleagues assessed Medicare claims for hospitalization and home health rehabilitation services — including physical, speech and occupational therapy — in 2012. They used the Medicare Outcomes and Information Set (OASIS) to link information from patients to each claim and the Medicare Master Beneficiary System File to collect demographic data.

Photo of older woman receiving home care 
A third of Medicare beneficiaries did not receive home health rehabilitation after being discharged from the intensive care unit, according to research presented at the Society of Critical Care Medicine’s Critical Care Congress.
Source: Adobe Stock

The analysis included 3,176 patients who stayed in the ICU for at least 24 hours during their hospitalization for a critical illness before being discharged. They received a median of 3.5 home rehabilitation visits within 30 days of discharge.

Falvey and colleagues found that 33% of patients did not receive a single visit in the 30 days after discharge.

Rehabilitation visits were more common among patients who were older (RR = 1.03; 95% CI, 1.01-1.04 per 5 years), had higher OASIS disability measure scores (RR = 1.03; 95% CI, 1.02-1.04 per point) and severe dyspnea (RR = 1.12; 95% CI, 1.04-1.21), according to the researchers.

In contrast, characteristics associated with fewer home health rehabilitation visits included having a higher comorbidity count (RR = 0.98; 95% CI, 0.96-0.99), living in rural regions (RR = 0.87; 95% CI, 0.81-0.97) and living alone (RR = 0.88; 95% CI, 0.81-0.96).

Although the researchers were not surprised that patients living in rural areas had fewer home health rehabilitation visits, Falvey said in the release that they were surprised to find that living alone was associated with fewer visits.

“It might be that those who lived alone were healthier and higher functioning or that they were perceived that way, so they weren’t provided referrals to home rehabilitation,” he added.

In the release, Falvey also noted that clinicians should be aware that patients living alone or in rural areas could be exposed to more post-discharge care disparities, and to ensure these patients receive the care they need to regain their mobility when they return home. – by Erin Michael

Reference:

Falvey J, et al. CT-55. Presented at: Society of Critical Care Medicine’s Critical Care Congress; Feb. 16-19, 2020; Orlando.

Disclosures: Falvey reports receiving royalties from MedBridge for a course related to hospital readmissions for rehabilitation professionals.