Does paid versus unpaid supplementary caregiving matter in preventable readmissions?

OBJECTIVES: To examine the impact of paid and unpaid supplementary caregiving on preventable readmissions among Medicare home health beneficiaries with diabetes. STUDY DESIGN: A retrospective cohort study with a home health episode as the unit of analysis. METHODS: We gathered multiple 2009 Medicare data and national datasets (eg, Area Health Resources File). We used propensity score matching based on beneficiaries' predisposing, enabling, and health need factors to create matched cohorts for episodes solely assisted by paid supplementary caregivers versus those solely assisted by unpaid supplementary caregivers. We applied Cox regression on the matched cohorts to estimate the 30-day preventable readmissions, including diabetes-related conditions, heart disease-related conditions, chronic obstructive pulmonary disease, urinary tract infection (UTI), pneumonia, and dehydration. RESULTS: Among beneficiaries (81,481) who received assistance several times during the day and night or several times during only the day, 7.34% were solely assisted by paid supplementary caregivers and 86.34% were solely assisted by unpaid supplementary caregivers. In the matched cohorts, we found that beneficiaries with paid supplementary caregivers had 68% higher hazards of readmission due to UTI than those with unpaid supplementary caregivers. CONCLUSIONS: The Medicare program is moving toward value-based purchasing and penalizing home health agencies with poor quality of care. It is critical for home health professionals to invite paid and unpaid supplementary caregivers to initiate care plans and assess their competence. Policies that support unpaid supplementary caregivers can also assist caregivers to care for their loved ones and prevent them from using expensive hospital resources.