Impact of Medicare eligibility on informal caregiving for surgery and stroke

Objective: To assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at age 65. Data Sources: Health and Retirement Study survey data (1998-2018). Study Design: We compared informal care received by patients hospitalized for stroke, heart surgery, or joint surgery and who were stratified into propensityweighted pre- and post-Medicare eligibility cohorts. A regression discontinuity design compared the self-reported likelihood of any care receipt, weekly hours of overall informal care, and intensity of informal care (hours among those receiving any care) at Medicare eligibility. Data Collection: Not applicable. Principal Findings: A total of 2270 individuals were included; 1674 (73.7%) stroke, 240 (10.6%) heart surgery, and 356 (15.7%) joint surgery patients. Mean (SD) care received was 20.0 (42.1) weekly hours. Of the 1214 (53.5%) patients who received informal care, the mean (SD) care receipt was 37.4 (51.7) weekly hours. Mean (SD) overall weekly care received was 23.4 (45.5), 13.9 (35.8), and 7.8 (21.6) for stroke, heart surgery, and joint surgery patients, respectively. The onset of Medicare eligibility was associated with a 13.6 percentage-point decrease in the probability of informal care received for stroke patients (p = 0.003) but not in the other acute care cohorts. Men had a 16.8 percentage-point decrease (p = 0.002) in the probability of any care receipt. Conclusions: Medicare coverage was associated with a substantial decrease in family and friend caregiving use for stroke patients. Informal care may substitute for rather than complement restorative care, given that Medicare is known to expand the use of postacute care. The observed spillover effect of Medicare coverage on informal caregiving has implications for patient function and caregiver burden and should be considered in episode-based reimbursement models that alter professional rehabilitative care intensity. KEYWORDS caregiving, discontinuity, Medicare, stroke, surgery What is known * Family and friend care is received by millions of older Americans * Medicare spends $124 billion on surgical care, $30 billion on stroke care, and is known to increase the use of postacute services for new enrollees * Informal care can substitute for maintenance and well-being assistance requiring less skilled support What this study adds * Older Medicare beneficiaries receive substantial family and friend caregiving after acute health events * Medicare eligibility is associated with decreased informal caregiving use for those who experience a stroke * Ongoing restorative services for stroke patients may decrease the need for complementary support from family and friends
1 | INTRODUCTION Each year, Medicare spends approximately $124 billion on surgical care, $30 billion on stroke care, and $60 billion on posthospital care. (1-4) It is well recognized that [...]