OBJECTIVES: To assess the effect of Alzheimer’s Disease and related dementias (ADRD) on home health care use patterns and cost outcomes in older US adults.

METHODS: This retrospective study using the US Medical Expenditure Panel Survey (MEPS, 2010-2016) identified participants aged ≥ 65 years and diagnosed with ADRD to examine the following outcomes: 1) home health care use, including prevalence, intensity, and provider type, and 2) annual home care costs. Older adults (≥ 65 years) without ADRD were controls. A two-part model examined the effect of ADRD on home health care costs. All data analyses applied person weights for national estimates.

RESULTS: Of the 15,330 eligible participants, 4.9% reported ADRD. The prevalence of home health care use was 45.7% in the ADRD group vs. 8.3% in the controls. Home care agencies provided 76.2% of home health services to the participants with ADRD. Home care aides and nurse practitioners delivered 75% of the home health services. The average number of days per person who received home care was 108 in the ADRD group vs. 56 in the control group (p<0.001). Annual home health care costs (per person) were $5,508 in the ADRD group vs. $713 in the controls (p<0.001). In the ADRD group, Medicare was the largest payer ($2,968), followed by Medicaid ($1,400) for home health care. After adjusting for participants' characteristics, those with ADRD were five times more likely to use home health care than controls (p<0.001). Home health care costs in the ADRD group were 282% higher than the control group after adjustment (p<0.001).

CONCLUSIONS: Home care agencies provided a large proportion of home health care. Home care aides and nurse practitioners were major home health care providers. ADRD increased the likelihood of home health care utilization and associated costs significantly.