# Caregiving after discharge from the hospital

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2022 · $533,248

## Abstract

PROJECT SUMMARY
Caregiving burden is a large and growing concern in the United States. The burden of caregiving is even
greater when the care recipient has Alzheimer's disease or related dementias (ADRD). Older adults are often
in particular need of assistance after hospitalization, during the post-acute period. This care has frequently
been provided in inpatient post-acute care settings, such as skilled nursing facilities (SNFs). Close to 20% of
hospital discharges go to a SNF and Medicare spent over $600 billion on post-acute care in 2015. Among
persons with dementia, the percentage of people discharged to SNFs for post-acute care is more than double
(48%), compared to the overall rate. Despite the large spending on SNFs, the value of inpatient post-acute
care to patients is uncertain. As a result, reducing its use has been a common target for payers such as
Medicare, particularly under alternative payment models that tie financial incentives to improving value and
reducing the costs of health care. Alternative payment models, such as bundled payment initiatives, have thus
resulted in a declining use of SNFs in the post-acute period. The shift toward discharging more patients directly
home after hospitalization may come at the expense of caregivers and families, however, particularly for
families of persons with dementia. This raises substantial concern about associated consequences, including
the increased amount of needed caregiving (both the frequency and intensity of caregiving) and potential loss
of work productivity due to these increased caregiving demands. Evaluating the impact of this shift on
caregiving is essential to gain a more complete understanding of the full costs of the increase in home-based
post-acute care. Our overall objective is to examine changes in caregiving in the post-acute period, particularly
among persons with dementia, as the use of inpatient post-acute care declines in the context of payment
reform. We will do so by combining several datasets (surveys and Medicare claims from 2011-2019) that
contain detailed information on caregiving during the post-acute period. Our specific aims are to describe
trends in the frequency, intensity, and total amount of caregiving in the post-acute period and the
characteristics of care recipients and their caregivers; to estimate changes in the frequency, intensity, and total
amount of caregiving during the post-acute period associated with implementation of bundled payment
initiatives; and to explore changes in work productivity among those who care for a family member (captured
via use of family medical leave) associated with bundled payment implementation. The results from this study
will provide empirical evidence regarding how the declining use of SNF has impacted caregiving in the post-
acute period.

## Key facts

- **NIH application ID:** 10408771
- **Project number:** 5R01AG066114-04
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Rachel M Werner
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $533,248
- **Award type:** 5
- **Project period:** 2019-09-30 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10408771

## Citation

> US National Institutes of Health, RePORTER application 10408771, Caregiving after discharge from the hospital (5R01AG066114-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10408771. Licensed CC0.

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