Home-based primary care did not decrease hospitalizations for persons living with dementia, but it did result in more patient- and family-centered end-of-life care.
Few health system or community-based interventions have reduced acute care utilization for people with dementia who are hospitalized frequently for falls, fractures, and infections. Home-based primary care (HBPC) has shown promise for other patients who are homebound and have complex chronic conditions. This study evaluates the impact of an HBPC program on hospital utilization and end-of-life care for people with dementia within an integrated health system of serious illness care. Qualitative interviews of family caregivers were also conducted to understand their experiences with HBPC.
Although patients with dementia receiving HBPC had a similar risk of hospital utilization compared to those who were not enrolled, they were more likely to receive home-based palliative care or hospice and to die at home. Family caregivers expressed that the HBPC program provided coordinated care that was aligned with the goals of patients and their families. Caregivers also reported unmet needs related to paying for custodial care and medical supplies.
Health systems and payers interested in expanding HBPC services may bring more person-centered end-of-life care to patients with dementia and their caregivers.