To examine variations in days at home among older dually eligible persons living with dementia (PLWD) across states, including among home- and community-based services (HCBS) users.
Approach:
Study Design: Cross-sectional study using 2021 Medicare and Medicaid claims data to identify dually eligible beneficiaries.
Population: Included 523,150 unique dually eligible PLWD, aged 65 years and older.
Outcome Definition: Days at home defined as the number of days per year a patient was alive without any emergency department, hospital, or nursing home use.
Data Analysis: Described sample characteristics, HCBS use, and days at home; analyzed state-level variation.
Key Findings:
Mean days at home for older dually eligible PLWD was 238.1 days in 2021.
HCBS users had a mean of 275.0 days at home.
Substantial state-level variation in days at home, ranging from 159.3 days in Kentucky to 311.7 days in Alaska.
Interpretation:
Limitations:
Reduced generalizability due to exclusion of some states with Medicaid managed care programs.
Potential bias from differential attrition across states due to mortality.
Limited information on beneficiaries’ health and functional status.
