Highly frail older breast cancer survivors often lack Medicare home health care

A new peer-reviewed study found that more than half of highly frail older breast cancer survivors did not use Medicare home health care in a given year, despite having substantial functional and health-care needs. The analysis, published in the Journal of the National Cancer Institute, examined Medicare-covered home health use among women ages 66 and older who were two to ten years past a diagnosis of invasive breast cancer.

Researchers analyzed 347,953 survivor-years representing 134,410 women in the study population. They linked cancer-registry records from the Surveillance, Epidemiology, and End Results Program with Medicare enrollment and claims data, as well as the Outcome and Assessment Information Set, which contains assessments completed by nurses and therapists when home health care begins. The data covered 2017 through 2020 and did not include Medicare Advantage.

To identify frailty among all survivors, including those who never received an in-home assessment, the team developed a claims-based frailty score. The score incorporated diagnoses and medical-equipment data and was calibrated against the frailty index used in the Outcome and Assessment Information Set. The measure captured accumulated health problems and functional limitations, including difficulty bathing or dressing, trouble walking, falls, memory problems, incontinence and exhaustion.

In any given year, approximately 7% of the breast cancer survivors were classified as highly frail, and about 40% of this group used Medicare home health care. Across all survivors, 11% used the service. The results therefore showed substantially higher use among highly frail survivors than among survivors overall, while also indicating that a majority of the most frail group received no Medicare home health care during the year. The study measured whether care was used, not whether each survivor met the requirements for coverage.

Traditional Medicare generally covers personal care at home only when it is connected to a skilled need and the beneficiary is homebound. The researchers noted that survivors whose main needs involved bathing, dressing and other personal care, or who were not homebound, could fall outside that coverage. They also found that women six to ten years from diagnosis were as frail as those two to five years from diagnosis, suggesting that the needs of long-term survivors may reflect aging as much as, or more than, effects of breast cancer treatment. The findings do not establish that lack of home health care caused falls or hospitalizations, but the authors said many highly frail survivors may need assistance that Medicare does not cover. They recommended routine frailty screening in survivorship care and broader coverage of personal care at home for frail survivors, noting that current survivorship guidelines do not call for routine screening.

Subject of Research: Medicare home health care use and unmet needs among highly frail older breast cancer survivors

Article Title: Older breast cancer survivors fall through Medicare home health gap

Article References: Older breast cancer survivors fall through Medicare home health gap. Original publication (Bibliographic details unavailable.)

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Keywords: breast cancer survivors, Medicare home health care, frailty, personal care, traditional Medicare, health disparities, aging, survivorship care, Older, breast, cancer, survivors