Medicare home-health use may not meet frailty-related needs of breast cancer survivors

Researchers linked SEER-Medicare claims with home-health assessment data to study 347,953 survivor-years from 2017 to 2020 among 134,410 women with invasive breast cancer, 2–10 years after diagnosis. They developed a claims-based predicted deficit-accumulation frailty index and assessed Medicare home-health (HH) use. Potential unmet need was defined as no HH use in survivor-years with a predicted frailty index of at least 0.25.

The claims-based index was calibrated against observed home-health assessment scores, with an area under the curve of 0.715 and a calibration slope of 1.111. Any HH use increased by 1.10 percentage points for each 0.01 increase in the frailty index. The increase was 1.21 points among survivors never eligible for both Medicare and Medicaid, compared with 0.41 points among those always eligible for both. Among high-need survivor-years, 59.6% had no Medicare HH use.

Long-term survivors had similar frailty scores to those 2–5 years after diagnosis, but lower HH use; potential unmet need did not differ. The findings suggest a gap between measured frailty-related need and Medicare HH use, but the study’s claims-based proxy and observational design do not establish whether individuals needed or would benefit from additional services. The authors suggest broader coverage of personal care and other home- and community-based services as a possible response.