Mortality and transitions-of-care after COVID-19 hospitalization among US Medicare patients: a retrospective claims analysis.

Publication date: May 28, 2026

The patient burden from COVID-19 extends beyond acute hospitalization, especially for older adults. The objective of this study was to describe post-discharge care settings and mortality rates after a COVID-19 hospitalization among adults aged ≥ 65 years in the United States. This retrospective observational study used the Medicare fee-for-service dataset. We identified Medicare patients hospitalized with COVID-19 from September 2023-February 2024. The date of discharge was the index date. Patients were followed until death, end of enrollment, or six months post-index. Pre- and post- hospitalization care settings, all-cause mortality, and readmission rates were analyzed. Patients were stratified by COVID-19 severity (general ward, intensive care unit [ICU], invasive mechanical ventilation [IMV]) and age (65-74, ≥ 75 years old). A total of 67,358 patients were included; most were female (55. 6%), white (84. 9%), and on average 80. 8 years (standard deviation: 8. 1). The majority (96. 4%) had ≥ 1 high-risk condition as defined by the Centers for Disease Control and Prevention (CDC). The median (interquartile range) length of stay was 5. 0 (3. 0-7. 0) days. During index hospitalization, 4. 4% of patients were admitted to the ICU and 5. 1% required IMV. Post-discharge, 50. 5% of patients who resided at home pre-hospitalization (self-care or under care) required increased care. Less than half (47. 8%) of patients who were home (self-care) pre-hospitalization returned home (self-care) upon discharge. A total of 11,658 (17. 4%) patients died within 6-months of hospital discharge. Mortality rates increased for patients requiring higher levels of care: 7. 1% of patients discharged home (self-care), 13. 0% of patients discharged home (under care), and 31. 8% discharged to any healthcare facility died within six months. Mortality was higher in those with more severe COVID-19 and those aged ≥ 75 years. The COVID-19-related readmission rate was 4. 5% within six months of discharge, and 3. 2% occurred within 30 days. The proportion of older adults who lost independence and required care (under care at home or at a healthcare facility) more than doubled after COVID-19 hospitalization, making the post-discharge period a particularly vulnerable time for patients, who are at risk for death and hospital readmission.

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