Chart of the Day: Home Health Care Use Rose Among Medicare Beneficiaries With Dementia Until the Pandemic

The Decline Since 2020 May Signal Gaps in Service and Access

May 16, 2025

By:

Miles Meline, MBE

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*Illustration is adapted from Figure 1 of the study.*

Nearly 7 million people in the United States live with dementia. While many individuals with dementia still reside in nursing homes, institutional care is decreasing, and a growing number are opting to receive care in the community.

Home care, while common across many populations, may be even more essential for individuals with dementia, as institutional settings can often be stressful and disorienting. As the population ages, understanding whether the health care system can adequately support care at home for these high-need individuals becomes crucial.

In this context, a new study by LDI Executive Director Rachel M. Werner and colleagues analyzed trends in the use of home-based care among traditional Medicare beneficiaries, focusing on those with and without dementia, from 2010 to 2022. The study provides important insights into the evolution of Medicare-funded home health care for people with dementia and highlights critical trends in home care utilization.

Among the 13.6 million traditional Medicare beneficiaries included in the study, 27% had a diagnosis of dementia. During the study period, 30.5 million new home health spells (i.e., care episodes) were initiated. Between 2010 and 2019, the number of new community-initiated and post-acute care home health spells increased among those with dementia by 17% and 21%, respectively. However, after 2020, both types of home health care declined. Community-initiated spells decreased by 17%, and post-acute care spells fell by almost 20% by mid-2022.

Home health use among beneficiaries without dementia was lower throughout the study period and, in contrast, it decreased: community-initiated care dropped by about 20%, and post-acute care fell by about 21%.

The findings underscore a critical issue: while home health care use among people with dementia increased over the past decade, the subsequent decline in 2020 and beyond may signal gaps in service availability and access. The reduction in home health care use during the COVID-19 pandemic highlights the ongoing vulnerability of this high-need population, emphasizing the need for continuous monitoring and policy interventions to ensure access to care. Policymakers must consider these trends to safeguard appropriate home-based care options for individuals with dementia, particularly as demand for such services is expected to grow.

The study, “Trends in Home Health Care Among Traditional Medicare Beneficiaries With or Without Dementia,” was published on May 16, 2025, in JAMA Network Open. Authors include Rachel M. Werner, Seiyoun Kim, and R. Tamara Konetzka.