Medicare System Fails Home Care Patients With Alzheimer’s

The Medicare home health model has failed patients with Alzheimer’s disease, according to recently published findings, which call into question the effectiveness of the home health prospective payment system (PPS).

The study, authored by William D. Cabin and published in the journal Social Work, argues that while the PPS has existed for 13 years, cracks in its foundation have limited the level of home health care Alzheimer’s patients receive — specifically from social workers.

While Medicare has always restricted coverage and reimbursement for a number of social work services, which now account for only 1% of all Medicare home health visits nationally, “PPS further limited the historical restriction of Alzheimer’s home health care by integrating fiscal requirements, practice decisions, and outcomes measurement,” he writes.


The policy occurs through Medicare’s first national home health assessment instrument, the Outcome and Assessment Information Set (OASIS), which, Cabin says, restricts care of patients with Alzheimer’s disease by not making Alzheimer’s a diagnosis that yields a high payment level.

Additionally, the policy restricts care by encouraging shorter stays and fewer services to increase profits on Home Health Resource Groups, and creating the highest payment incentives for people with short-stay, intensive physical, speech, and occupational therapy needs, which is not a characteristic of people with Alzheimer’s disease.

“Alzheimer’s disease has been recognized as a chronic, progressively debilitating disease, with most of those with the disease being elderly people who remain at home for prolonged time periods,” Cabin writes. “As such, it is the epitome of the failure of the Medicare home health benefit to address the reality of a major and growing disease affecting elderly quality of life and mortality.”


By avoiding treating these individuals, the unmet needs created by the non coverage of psychosocial care surface and may even lead to further exacerbation of patient physical and mental health.

However, research shows that the increased use of social work services and psychosocial care can improve both patient and caregiver quality of life and reduce patient, caregiver and government costs, the report concludes.

Access the study here.

Written by Emily Study