title: Evaluation of geriatric home healthcare depression assessment and care management: are OASIS-C depression requirements enough?
abstract: OBJECTIVE
  Research is scarce on how depression is identified and treated among Medicare home healthcare (HHC) patients age 65+ with disability. The Centers for Medicare & Medicaid Services (CMS) recently incorporated depression screening into the OASIS-C HHC assessment. Our study objectives were to evaluate and characterize depression care management (DCM) in an HHC agency after CMS increased its depression requirements and to determine if there was an association of DCM with disability (activities of daily living [ADLs]) outcomes.
  
  
  METHODS
  The authors conducted a retrospective chart review of 100 new Medicare HHC admissions patients age 65+ (mean age: 81.7) who screened positive for depression and had disability and multimorbidity. Clinical and administrative records were examined and descriptive analyses used. Multivariate regression analyses investigated the association of six DCM components with ADLs improvement.
  
  
  RESULTS
  Depression was recognized in care plans of 60% of patients. Documentation of only one nurse care management activity, antidepressant use, indicated the use of evidence-based standards of depression assessment and DCM. Depression measures were not administered at discharge, recertification, or transfer. Forty percent of patients had a formal depression diagnosis by the referring physician in the chart, and 65% were receiving an antidepressant. Having a depression care plan and depression medication were significantly associated with a large ADLs improvement.
  
  
  CONCLUSIONS
  Despite the association of depression care plans with patient disability improvement, inadequate compliance to evidence-based DCM was found. Medicare and HHC agencies must ensure compliance to DCM, including follow-up depression assessment for patients with positive screens.
authors.affiliation: University of Rochester School of Nursing, Rochester, NY. Electronic address: Dianne_Liebel@urmc.rochester.edu.
authors.forename: Dianne V
authors.initials: DV
authors.lastname: Liebel
authors.affiliation: Departments of Public Health Sciences and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Bruce
authors.initials: B
authors.lastname: Friedman
authors.affiliation: Departments of Public Health Sciences and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Yeates
authors.initials: Y
authors.lastname: Conwell
authors.affiliation: University of Rochester School of Nursing, Rochester, NY.
authors.forename: Bethel Ann
authors.initials: BA
authors.lastname: Powers
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis*; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006699:Home Care Services; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D010346:Patient Care Management; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States
keywords: Home healthcare; disability; nurse depression care management