Factors Associated With an Elder Mistreatment Diagnosis Among Medicare Home Health Care Recipients

Objectives To identify risk factors of elder mistreatment (EM) diagnosis among Medicare fee-for-service beneficiaries receiving Medicare Home Health Care (HHC). Design Longitudinal retrospective cohort study. Setting and Participants Beneficiaries aged 66 and older receiving HHC in 2016, without an EM diagnosis in 2015 or 2016, and Medicare Part A/B/D eligible with no HMO through 2018 were included (N = 270,935). Methods Predictor variables from 20% national Medicare claims (eg, demographics, health conditions, social determinants of health) and the Outcomes and Assessment Information Set (OASIS; eg, cognition, mobility, behavioral problems, living situation) were included. Cox proportional hazards regression assessing beneficiary health and social characteristics associated with an EM diagnosis was conducted. Results HHC patients were mostly women (66.7%) and non-Hispanic White (81.3%) with 27.2% Medicaid dual eligible. EM diagnosis prevalence was 0.3%. Significant EM diagnosis risk factors through a 3-year period were illiteracy [hazard ratio (HR), 17.82; 95% CI, 6.26–50.73], housing and income problems (HR, 4.38; 95% CI, 2.21–8.69), history of traumatic brain injury (HR, 2.32; 95% CI, 1.11–4.88), and chronic conditions such as learning disabilities (HR, 2.83; 95% CI, 1.32–6.08), posttraumatic stress disorder (HR, 1.86; 95% CI, 1.06–3.28), alcohol use disorder (HR, 1.64; 95% CI, 1.17–2.31), and mobility impairment (HR, 1.52; 95% CI, 1.16–1.99). Medicare due to disability (HR, 1.66; 95% CI, 1.34–2.06) and HHC behavioral diagnoses (HR, 1.34; 95% CI, 1.02–1.75) also showed increased EM diagnosis risk. Conclusions and Implications Findings underscore the utility of combining Medicare claims data and clinician-assessed patient outcomes to provide a comprehensive examination of factors contributing to EM diagnosis.