Racial disparities and socioeconomic factors associated with post-acute rehabilitation facility utilization among Nevadans with Alzheimer's disease and related disorders and extremity fractures: insights of age-friendly and dementia-friendly state planning in U.S.

BACKGROUND

Falls and extremity fractures often occur in people living with Alzheimer's disease and related disorders (ADRD). In post-fracture care, these patients are cared for either at rehabilitation facilities or their homes. The coronavirus disease 2019 (COVID-19) pandemic limited the utilization of rehabilitation facilities. In areas with provider shortages, this trend poses a risk of disability and caregiver burdens, particularly in racial minorities who under-utilize rehabilitation facilities.

OBJECTIVE

To assess racial disparities in post-acute care (PAC) at rehabilitation facilities among people living with ADRD and extremity fractures during the COVID-19 pandemic.

METHODS

We summarized the PAC locations by (1) rehabilitation facilities (skilled nursing facilities and inpatient rehabilitation facilities) and (2) homes (homes with self-care and homes with services) for each study year. We observed the yearly percentage trends in PAC at rehabilitation facilities over the total post-acute discharge period. We assessed demographics (age, sex, and race), clinical comorbidities (fracture sites), utilization factors (pay source and hospital location), and COVID-19 pandemic status (pre-/post-pandemic years). We used multivariate logistic regression to estimate the association between these factors and PAC in the rehabilitation facilities.

RESULTS

The proportion of individuals receiving PAC declined in rehabilitation facilities, whereas the proportion of individuals receiving PAC at home with services continuously increased. Being Hispanic, presence of cerebrovascular disorder (CVD), use of Medicaid services, and the COVID-19 pandemic were associated with lower probabilities of utilizing rehabilitation facilities.

CONCLUSION

Among the individuals with ADRD and extremity fractures, the proportion of those who underutilized rehabilitation facilities was higher in Hispanics compared with other races. Caregiving for Hispanics, presence of CVD, and use of Medicaid services were associated with the risk of disability and caregiver burden, due to shifting trends from rehabilitation facilities to homes with services. Geriatric workforce education should be prioritized to enhance the competencies of healthcare providers serving these individuals to relieve caregiver burdens in areas with provider shortage.