Family Caregiver Training Needs and Medicare Home Health Visit Utilization

BACKGROUND: Medicare home health providers are now required to deliver family caregiver training, but potential consequences for service intensity are unknown. OBJECTIVE: The objective of this study was to assess how family caregiver training needs affect the number and type of home health visits received. DESIGN: Observational study using linked National Health and Aging Trends Study (NHATS), Outcomes and Assessment Information Set (OASIS), and Medicare claims data. Propensity score adjusted, multivariable logistic, and negative binomial regressions model the relationship between caregivers' training needs and number/type of home health visits. SUBJECTS: A total of 1217 (weighted n=5,870,905) National Health and Aging Trends Study participants receiving Medicare-funded home health between 2011 and 2016. MEASURES: Number and type of home health visits, from Medicare claims. Family caregivers' training needs, from home health clinician reports. RESULTS: Receipt of nursing visits was more likely when family caregivers had medication management [adjusted odds ratio (aOR): 3.03; 95% confidence interval (CI): 1.06, 8.68] or household chore training needs (aOR: 3.38; 95% CI: 1.33, 8.59). Receipt of therapy visits was more likely when caregivers had self-care training needs (aOR: 1.70; 95% CI: 1.01, 2.86). Receipt of aide visits was more likely when caregivers had household chore (aOR: 3.54; 95% CI: 1.82, 6.92) or self-care training needs (aOR: 2.12; 95% CI: 1.11, 4.05). Medication management training needs were associated with receiving an additional 1.06 (95% CI: 0.11, 2.01) nursing visits, and household chores training needs were associated with an additional 3.24 total (95% CI: 0.21, 6.28) and 1.32 aide visits (95% CI: 0.36, 2.27). CONCLUSION: Family caregivers' activity-specific training needs may affect home health visit utilization.