The Impact of Home Health Physical Therapy on Medicare Beneficiaries With a Primary Diagnosis of Dementia

The article below is presented to us by Clay Watson, PT, Past President, Home Health and Hospice Association of Utah.
“We have been hearing that some consultants have been telling Home Health Agencies that people with dementia should not be receiving Physical Therapy under the home health benefit. The Homecare and Hospice Association of Utah wishes to dispel this incredibly inappropriate misinformation and stress the benefits of Physical Medicine and Rehab to improve ADL function in people with dementia.
This is in pre-publication so we can’t get the full article yet. Hopefully, the abstract is a good starting point.



Dementia is a leading cause of disability for adults older than 65 years. Exercise intervention slows functional decline and improves balance; however, the efficacy of physical therapy (PT) services for persons with dementia is unknown. The purpose of this study is to assess the effect of home health PT services on physical function for Medicare beneficiaries with a primary diagnosis of dementia.


Observational cohort study using a combined Medicare data set of home health beneficiaries; we performed augmented inverse probability weighted regression with demographic, comorbidity, and symptom-level characteristics analyzed as covariates.


Home healthcare, United States, 2012.


Medicare beneficiaries who had a primary diagnosis of dementia and home health function evaluations at discharge (n = 1477).


PT treatment, examined by (1) any PT and (2) PT visit number.


Improvement in composite activity of daily living (ADL) scores from home health admit to discharge.


Any PT increased the probability of improvement in ADLs by 15.2% (P < .001). Compared to 1 to 5 PT visits, 6 to 13 visits increased the probability of ADL improvement by 11.6% (P < .001).


PT intervention is beneficial for ADL function improvement in Medicare home health beneficiaries with a primary diagnosis of dementia.

© 2020 The American Geriatrics Society. [Members Stevens-Lapsely and Falvey are co-authors.]

Jason Falvey, DPT, PHD is on the Geriatric Research team at Yale and has been producing a series of outcome based research specific to home health PT. He often stresses the need to look at the dose-response for any of our patients. It would be inappropriate to do weeks and weeks of therapy for this population. However, providing a closely prescribed and monitored amount of Physical Therapy for someone with dementia is both beneficial and appropriate

Activities of Daily Living require a mix of physical and cognitive function. My anecdotal experience is that people with dementia seem to do well with Occupational Therapy and Speech Therapy because they can perform therapy in context of ADL’s. As a Physical Therapist, sometimes my best intervention is finding the right clinician for the right patient. I often try to bring in OT or ST to help with these cases and defer to their plan of care, depending on the therapist I’m working with.”
Clay Watson, PT
Past President, Home Health and Hospice Association of Utah
Owner, Western Summit Rehabilitation

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