COVID-19 hospitalization place of live discharge outcomes for long-term care facility residents with dementia: Mediation by comorbidities index scores and moderation by health insurance status

Background and aim: COVID-19 hospitalization place of discharge outcomes for Long Term Care Facility (LTCF) residents with dementia are less well known for preventing excess mortality in this vulnerable population. Method: This cross-sectional study utilized the Texas Inpatient Public Use Data File (PUDF) data on LTCF residents with dementia (n = 1,413) and without dementia (n = 1,674) to examine variations in their hospitalization outcomes of live place of discharge, comorbidity scores, and health insurance status. Results: Dementia diagnosis increased risks of hospice care (OR = 1.44, 95 %CI = 1.16-1.80), while decreasing the likelihood of discharge to recovery hospitals by almost 30 % (OR = 0.70, 95 %CI = 0.52-0.94). Higher Elixhauser Comorbidity Index Score (ECIS) significantly mediated the relationship between dementia and hospice care discharge (indirect effect = 0.07, p < 0.01, R² = 0.09). Health insurance significantly moderated the relationship between dementia and hospice discharge, with for a lower probability of discharge to hospice care with health maintenance organization insurance (β = -0.51, p < 0.05, R² = 0.09). Conclusion and implication: Covid-19 discharge plans for patients with dementia should prioritize recovery hospitals rather than hospice care for minimizing health care disparities compared to other residents. Given the increased risk of hospice discharge among dementia patients, healthcare providers should integrate comorbidity burden assessments into discharge planning. Conceivably, dementia patients with higher ECIS may face systemic barriers to recovery-focused care if carers paid less regard to the role of comorbidities in hospitalization outcomes.