Gaps in Access to Home and Community-Based Services Following Inpatient Rehabilitation for Traumatic Brain Injury in Older Adults.

BACKGROUND

Older adults with traumatic brain injury (TBI) often experience residual self-care and mobility limitations after discharge from inpatient rehabilitation facilities (IRFs). Occupational therapy (OT) and physical therapy (PT) in home health or outpatient settings can address these limitations, yet access is poorly understood.

OBJECTIVE

Determine whether need for OT (self-care limitations) and PT (mobility limitations) at IRF discharge is associated with community rehabilitation utilization, and whether non-clinical factors are independently associated with utilization.

DESIGN

Cohort study using Medicare claims and assessment data. Modified Poisson regression estimated receipt of home health OT, home health PT, outpatient OT, and outpatient PT post-IRF discharge as a function of self-care and mobility performance, non-clinical factors, and clinical covariates.

PARTICIPANTS

Community-dwelling older adults who received inpatient rehabilitation for TBI from 2020 to 2022 (n = 23,036).

INTERVENTIONS: Not applicable.

MAIN MEASURES: Clinical need was defined using discharge Section GG self-care and mobility performance scores. Receipt of community rehabilitation was identified within 90 days post-IRF discharge.

KEY

RESULTS

Most rehabilitation occurred via home health (OT 52%; PT 67%); only 15% received outpatient OT and 27% received outpatient PT. Worse self-care was associated with home health and outpatient OT use. Worse mobility predicted home health PT, but mobility did not predict outpatient PT use. Non-clinical factors were independently associated with a decreased likelihood of home health utilization, including younger age; Hispanic ethnicity (vs. White, non-Hispanic); and rurality. Similarly, beneficiaries who were older; identified as Black or Hispanic (vs. White, non-Hispanic); unmarried; or eligible for Medicaid were less likely to receive outpatient rehabilitation.

CONCLUSIONS

Community rehabilitation was common, but care was concentrated in home health. Clinical need was not a dominant driver of utilization, and non-clinical factors shaped access. Findings highlight gaps in utilization of beneficial rehabilitative care upon discharge and reveal targets for improving transitional services.