Acute Care Utilization and Cost Outcomes of Home-Based Palliative Care for Persons Living with Dementia in the United States: A Systematic Review

Background: Given the shift toward value-based payment models, which reward high-quality and cost-effective care, an increasing number of palliative care programs are being integrated across care settings in health systems and organizations in the United States to reduce patient use of more costly services such as hospitalization and emergency department (ED) visits. Home-based palliative care (HBPalC) is one community-based palliative care delivery model that may help delay facility and nursing home placement and reduce hospital use and costs. Objective: This review synthesized evidence on hospital utilization and cost outcomes associated with HBPalC among people living with dementia (PLWD) in the United States. Method: PubMed, Embase, and Cumulated Index in Nursing and Allied Health Literature were searched from inception through October 2025. All U.S.-based studies were included if samples included PLWD and the study examined the impact of HBPalC on hospital utilization (i.e., hospitalization and ED use) or health care costs. Results: A total of eight studies were included. Overall, HBPalC provided core services such as symptom management and advanced care planning. PLWD-specific HBPalC focused on addressing neurobehavioral symptoms and supporting caregivers. HBPalC was consistently associated with reductions in hospitalization and associated costs, although evidence for changes in ED utilization was not available, with no studies reporting ED outcomes for PLWD specifically. Conclusion: HBPalC was associated with reduced hospitalization, but its impact on ED use was inconclusive for PLWD. Most studies had heterogeneous patient samples and did not report PLWD-specific outcomes. There is a lack of HBPalC specifically designed for PLWD, and more studies are needed to evaluate HBPalC’s impact on ED use among PLWD.