Payment Models and Quality in Post-Acute and Long-Term Care for Older Adults and People Living With Dementia

Older adults and people living with dementia often rely on post-acute care (PAC) and long-term care (LTC) services across settings such as skilled nursing facilities, home health, assisted living, nursing homes, hospice, and community-based programs. Yet, payment models used to finance these services can strongly shape care quality, access, workforce capacity, care coordination, and outcomes for patients and families. As health systems shift from volume-based reimbursement to value-based purchasing and risk-sharing approaches, there is a growing need to understand which payment designs improve quality—and for whom—without creating unintended harms such as reduced access, inequities, under-provision of care, or inappropriate transfers.This Research Topic will examine how payment policies and reimbursement structures influence the quality of PAC and LTC for older adults, with a particular focus on people living with dementia and their caregivers. We welcome multidisciplinary contributions that evaluate existing and emerging payment models, identify mechanisms that link payment incentives to care delivery, and propose actionable solutions for improving quality, equity, and person-centered outcomes across the care continuum.Key themes may include (but are not limited to):1. Value-based purchasing, bundled payments, capitation, managed care, and pay-for-performance in PAC/LTC2. Payment incentives and their effects on staffing, turnover, skill mix, training, and workforce stability3. Quality measurement: design, validity, and unintended consequences (including gaming and “teaching to the measure”)4. Equity impacts of payment reforms (race/ethnicity, socioeconomic status, rurality, disability, dementia severity)5. Care transitions and integration across hospitals, PAC, LTC, home- and community-based services, and hospice6. Dementia-specific payment approaches that support person-centered care, caregiver support, and behavioral health needs7. Financial incentives, service utilization, and outcomes (rehospitalizations, functional status, quality of life, end-of-life care)8. International comparisons of PAC/LTC financing and quality frameworks9. Policy evaluations using real-world data, natural experiments, and implementation science approaches10. Innovative models that align payment with person-centered outcomes (including caregiver outcomes)By bringing together evidence from health services research, geriatrics, nursing, economics, public policy, and implementation science, this Research Topic aims to support better payment strategies that promote high-quality, equitable care for older adults and people living with dementia. Topic editors: Rashmita Basu Source: https://www.frontiersin.org/research-topics/77053/payment-models-and-quality-in-post-acute-and-long-term-care-for-older-adults-and-people-living-with-dementia