To determine the frequency and characteristics of homebound older adults with Parkinson Disease.

Homebound status is associated with decreased specialty care in the general Medicare population. Women and minorities with Parkinson disease (PD) are highly underrepresented in specialty care clinics.  The relationship between specialty care use and homebound status may be bidirectional, with lower quality care producing greater disability, and disability preventing specialty care access. Knowing the epidemiology of the homebound PD population may shed light on care and outcome disparities.

This cross sectional study of Medicare beneficiaries ages 65 and above used 2014 claims data. We identified individuals diagnosed with Parkinson Disease in outpatient or inpatient encounters. Home health care services require provider certification that an individual is homebound, thus homebound status was defined as at least one incident of home health care during the calendar year.  Homebound prevalence was calculated for the PD sample.  Logistic regression models examined race/ethnicity, sex, and age as predictors of homebound status, and examined the association of homebound status with diagnoses of depression and anxiety.

We identified 509, 250 Medicare beneficiaries diagnosed with PD in 2014.  Of these, 22.9% (n=151,668) were homebound at some time during the year.  Demographic variables positively associated with homebound status were female sex (AOR 1.11, 1.10-1.13), Black race (AOR 1.26, 1.23-1.29), Hispanic ethnicity (AOR 1.23, 1.19-1.28) and increasing age. Asian race was negatively associated with being homebound (AOR 0.80, 0.77-0.84). Being homebound was positively associated with depression (AOR 1.94, 1.91-1.96) and anxiety (AOR 1.74, 1.71-1.76)

Nearly one quarter of Medicare beneficiaries with PD are homebound annually. Homebound status is more likely among demographic groups who are also less likely to receive specialist care. Future studies will examine the nature and direction of functional limitations in Parkinson disease, particularly with respect to demographic care and outcomes disparities.