{"doi":"10.1016/j.jamda.2025.105498","title":"Trends in the Use of Medicare Home Health Care among Congregate Living Residents","abstract":"OBJECTIVE: To examine trends in home health care (HHC) use in congregate living and compare characteristics of HHC use between Medicare patients in congregate living and those in other home settings. DESIGN: Retrospective cohort study describing HHC use, in and outside of congregate living, using national Medicare claims, assessment, and administrative data (2014-2019). We compared HHC use by setting, on HHC quality, planned visit quantity, referral source (post-acute or community-initiated), and recertifications. We additionally examined whether HHC patterns across settings differed by patient dual eligibility and race-ethnicity. SETTING AND PARTICIPANTS: Traditional Medicare (TM) and Medicare Advantage (MA) HHC patients aged 67 and older in congregate living or elsewhere. METHODS: Multivariable regressions. RESULTS: 15.9% of HHC episodes in 2018-2019 were in congregate living, which increased 20.5% between 2014 and 2019. TM patients in congregate living were 4.4% (2.3 ppt, 95% CI: 1.7, 2.9) more likely to use high-quality agencies, had 8.7% (0.7 visits, 95% CI: 0.7, 0.8) more planned visits, were 27.6% (14.9 ppt, 95% CI: 14.7, 15.1) more likely to have community-initiated referrals, and 9.9% (3.2 ppt, 95% CI: 2.9, 3.5) more likely to be recertified compared with TM patients in other settings; differences were similar between settings among MA enrollees. Compared with their counterparts, dually eligible and racial-ethnic minoritized populations in congregate living were 2.6% (-1.5 ppt, 95% CI: -2.2, -0.8%) and 1.6% less likely (-0.9 ppt, 95% CI: -1.6, -0.3%) to use high-quality agencies, respectively, and dually eligible patients in congregate living had 6% fewer planned visits (-0.64 visits, 95% CI: -0.72, -55); these differences persisted across settings. CONCLUSION AND IMPLICATIONS: Congregate living may have facilitated access to higher quality and quantity of HHC, but inequitably. Further research is needed to determine the value of high-frequency community-initiated HHC referrals in congregate living.","journal":"Journal of the American Medical Directors Association","year":2025,"id":562213,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7062,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1464590,"name":"Bo Zheng","orcid":"0000-0003-4562-3183","position":1,"is_corresponding":false},{"id":325716,"name":"Brian E. McGarry","orcid":"0000-0001-5342-6548","position":2,"is_corresponding":false},{"id":1083845,"name":"Jun Li","orcid":"0000-0002-7829-0752","position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":null,"created_at":"2026-07-19T02:56:05.550545Z","pmid":"39956155","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}