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Global wetlands are the largest and most uncertain natural source of atmospheric methane (CH4). The FLUXNET-CH4 synthesis initiative has established a global network of flux tower infrastructure, offering valuable data products and fostering a dedicated community for the measurement and analysis of methane flux data. Existing studies using the FLUXNET-CH4 Community Product v1.0 have provided invaluable insights into the drivers of ecosystem-to-regional spatial patterns and daily-to-decadal temporal dynamics in temperate, boreal, and Arctic climate regions. However, as the wetland CH4 monitoring network grows, there is a critical knowledge gap about where new monitoring infrastructure ought to be located to improve understanding of the global wetland CH4 budget. Here we address this gap with a spatial representativeness analysis at existing and hypothetical observation sites, using 16 process-based wetland biogeochemistry models and machine learning. We find that, in addition to eddy covariance monitoring sites, existing chamber sites are important complements, especially over high latitudes and the tropics. Furthermore, expanding the current monitoring network for wetland CH4 emissions should prioritize, first, tropical and second, sub-tropical semi-arid wetland regions. Considering those new hypothetical wetland sites from tropical and semi-arid climate zones could significantly improve global estimates of wetland CH4 emissions and reduce bias by 79% (from 76 to 16 TgCH4 y−1), compared with using solely existing monitoring networks. Our study thus demonstrates an approach for long-term strategic expansion of flux observations.

Wetland methane (CH4) emissions over the Boreal-Arctic region are vulnerable to climate change and linked to climate feedbacks, yet understanding of their long-term dynamics remains uncertain. Here, we upscaled and analysed two decades (2002-2021) of Boreal-Arctic wetland CH4 emissions, representing an unprecedented compilation of eddy covariance and chamber observations. We found a robust increasing trend of CH4 emissions (+8.9%) with strong inter-annual variability. The majority of emission increases occurred in early summer (June and July) and were mainly driven by warming (52.3%) and ecosystem productivity (40.7%). Moreover, a 2 °C temperature anomaly in 2016 led to the highest recorded annual CH4 emissions (22.3 Tg CH4 yr-1) over this region, driven primarily by high emissions over Western Siberian lowlands. However, current-generation models from the Global Carbon Project failed to capture the emission magnitude and trend, and may bias the estimates in future wetland CH4 emission driven by amplified Boreal-Arctic warming and greening.

Process-based land surface models are important tools for estimating global wetland methane (CH4) emissions and projecting their behavior across space and time. So far there are no performance assessments of model responses to drivers at multiple time scales. In this study, we apply wavelet analysis to identify the dominant time scales contributing to model uncertainty in the frequency domain. We evaluate seven wetland models at 23 eddy covariance tower sites. Our study first characterizes site-level patterns of freshwater wetland CH4 fluxes (FCH4) at different time scales. A Monte Carlo approach was developed to incorporate flux observation error to avoid misidentification of the time scales that dominate model error. Our results suggest that (a) significant model-observation disagreements are mainly at multi-day time scales (32 days) for the boreal and Arctic tundra wetland sites but have significant bias in variability at seasonal time scales for temperate and tropical/subtropical sites; (c) model errors exhibit increasing power spectrum as time scale increases, indicating that biases at time scales

Wetlands are responsible for 20%–31% of global methane (CH4) emissions and account for a large source of uncertainty in the global CH4 budget. Data-driven upscaling of CH4 fluxes from eddy covariance measurements can provide new and independent bottom-up estimates of wetland CH4 emissions. Here, we develop a six-predictor random forest upscaling model (UpCH4), trained on 119 site-years of eddy covariance CH4 flux data from 43 freshwater wetland sites in the FLUXNET-CH4 Community Product. Network patterns in site-level annual means and mean seasonal cycles of CH4 fluxes were reproduced accurately in tundra, boreal, and temperate regions (Nash-Sutcliffe Efficiency ∼0.52–0.63 and 0.53). UpCH4 estimated annual global wetland CH4 emissions of 146 ± 43 TgCH4 y−1 for 2001–2018 which agrees closely with current bottom-up land surface models (102–181 TgCH4 y−1) and overlaps with top-down atmospheric inversion models (155–200 TgCH4 y−1). However, UpCH4 diverged from both types of models in the spatial pattern and seasonal dynamics of tropical wetland emissions. We conclude that upscaling of eddy covariance CH4 fluxes has the potential to produce realistic extra-tropical wetland CH4 emissions estimates which will improve with more flux data. To reduce uncertainty in upscaled estimates, researchers could prioritize new wetland flux sites along humid-to-arid tropical climate gradients, from major rainforest basins (Congo, Amazon, and SE Asia), into monsoon (Bangladesh and India) and savannah regions (African Sahel) and be paired with improved knowledge of wetland extent seasonal dynamics in these regions. The monthly wetland methane products gridded at 0.25° from UpCH4 are available via ORNL DAAC (https://doi.org/10.3334/ORNLDAAC/2253).

UNLABELLED: Wetlands cover a small portion of the world, but have disproportionate influence on global carbon (C) sequestration, carbon dioxide and methane emissions, and aquatic C fluxes. However, the underlying biogeochemical processes that affect wetland C pools and fluxes are complex and dynamic, making measurements of wetland C challenging. Over decades of research, many observational, experimental, and analytical approaches have been developed to understand and quantify pools and fluxes of wetland C. Sampling approaches range in their representation of wetland C from short to long timeframes and local to landscape spatial scales. This review summarizes common and cutting-edge methodological approaches for quantifying wetland C pools and fluxes. We first define each of the major C pools and fluxes and provide rationale for their importance to wetland C dynamics. For each approach, we clarify what component of wetland C is measured and its spatial and temporal representativeness and constraints. We describe practical considerations for each approach, such as where and when an approach is typically used, who can conduct the measurements (expertise, training requirements), and how approaches are conducted, including considerations on equipment complexity and costs. Finally, we review key covariates and ancillary measurements that enhance the interpretation of findings and facilitate model development. The protocols that we describe to measure soil, water, vegetation, and gases are also relevant for related disciplines such as ecology. Improved quality and consistency of data collection and reporting across studies will help reduce global uncertainties and develop management strategies to use wetlands as nature-based climate solutions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13157-023-01722-2.

Wetland CH₄ emissions are among the most uncertain components of the global CH₄ budget. The complex nature of wetland CH₄ processes makes it challenging to identify causal relationships for improving our understanding and predictability of CH₄ emissions. In this study, we used the flux measurements of CH₄ from eddy covariance towers (30 sites from 4 wetlands types: bog, fen, marsh, and wet tundra) to construct a causality-constrained machine learning (ML) framework to explain the regulative factors and to capture CH₄ emissions at sub-seasonal scale. We found that soil temperature is the dominant factor for CH₄ emissions in all studied wetland types. Ecosystem respiration (CO₂) and gross primary productivity exert controls at bog, fen, and marsh sites with lagged responses of days to weeks. Integrating these asynchronous environmental and biological causal relationships in predictive models significantly improved model performance. More importantly, modeled CH₄ emissions differed by up to a factor of 4 under a +1°C warming scenario when causality constraints were considered. These results highlight the significant role of causality in modeling wetland CH₄ emissions especially under future warming conditions, while traditional data-driven ML models may reproduce observations for the wrong reasons. Our proposed causality-guided model could benefit predictive modeling, large-scale upscaling, data gap-filling, and surrogate modeling of wetland CH₄ emissions within earth system land models.

Time series of wetland methane fluxes measured by eddy covariance require gap-filling to estimate daily, seasonal, and annual emissions. Gap-filling methane fluxes is challenging because of high variability and complex responses to multiple drivers. To date, there is no widely established gap-filling standard for wetland methane fluxes, with regards both to the best model algorithms and predictors. This study synthesizes results of different gap-filling methods systematically applied at 17 wetland sites spanning boreal to tropical regions and including all major wetland classes and two rice paddies. Procedures are proposed for: 1) creating realistic artificial gap scenarios, 2) training and evaluating gap-filling models without overstating performance, and 3) predicting half-hourly methane fluxes and annual emissions with realistic uncertainty estimates. Performance is compared between a conventional method (marginal distribution sampling) and four machine learning algorithms. The conventional method achieved similar median performance as the machine learning models but was worse than the best machine learning models and relatively insensitive to predictor choices. Of the machine learning models, decision tree algorithms performed the best in cross-validation experiments, even with a baseline predictor set, and artificial neural networks showed comparable performance when using all predictors. Soil temperature was frequently the most important predictor whilst water table depth was important at sites with substantial water table fluctuations, highlighting the value of data on wetland soil conditions. Raw gap-filling uncertainties from the machine learning models were underestimated and we propose a method to calibrate uncertainties to observations. The python code for model development, evaluation, and uncertainty estimation is publicly available. This study outlines a modular and robust machine learning workflow and makes recommendations for, and evaluates an improved baseline of, methane gap-filling models that can be implemented in multi-site syntheses or standardized products from regional and global flux networks (e.g., FLUXNET).

While wetlands are the largest natural source of methane (CH4 ) to the atmosphere, they represent a large source of uncertainty in the global CH4 budget due to the complex biogeochemical controls on CH4 dynamics. Here we present, to our knowledge, the first multi-site synthesis of how predictors of CH4 fluxes (FCH4) in freshwater wetlands vary across wetland types at diel, multiday (synoptic), and seasonal time scales. We used several statistical approaches (correlation analysis, generalized additive modeling, mutual information, and random forests) in a wavelet-based multi-resolution framework to assess the importance of environmental predictors, nonlinearities and lags on FCH4 across 23 eddy covariance sites. Seasonally, soil and air temperature were dominant predictors of FCH4 at sites with smaller seasonal variation in water table depth (WTD). In contrast, WTD was the dominant predictor for wetlands with smaller variations in temperature (e.g., seasonal tropical/subtropical wetlands). Changes in seasonal FCH4 lagged fluctuations in WTD by ~17 ± 11 days, and lagged air and soil temperature by median values of 8 ± 16 and 5 ± 15 days, respectively. Temperature and WTD were also dominant predictors at the multiday scale. Atmospheric pressure (PA) was another important multiday scale predictor for peat-dominated sites, with drops in PA coinciding with synchronous releases of CH4 . At the diel scale, synchronous relationships with latent heat flux and vapor pressure deficit suggest that physical processes controlling evaporation and boundary layer mixing exert similar controls on CH4 volatilization, and suggest the influence of pressurized ventilation in aerenchymatous vegetation. In addition, 1- to 4-h lagged relationships with ecosystem photosynthesis indicate recent carbon substrates, such as root exudates, may also control FCH4. By addressing issues of scale, asynchrony, and nonlinearity, this work improves understanding of the predictors and timing of wetland FCH4 that can inform future studies and models, and help constrain wetland CH4 emissions.

Large datasets of greenhouse gas and energy surface-atmosphere fluxes measured with the eddy-covariance technique (e.g., FLUXNET2015, AmeriFlux BASE) are widely used to benchmark models and remote-sensing products. This study addresses one of the major challenges facing model-data integration: To what spatial extent do flux measurements taken at individual eddy-covariance sites reflect model- or satellite-based grid cells? We evaluate flux footprints—the temporally dynamic source areas that contribute to measured fluxes—and the representativeness of these footprints for target areas (e.g., within 250–3000 m radii around flux towers) that are often used in flux-data synthesis and modeling studies. We examine the land-cover composition and vegetation characteristics, represented here by the Enhanced Vegetation Index (EVI), in the flux footprints and target areas across 214 AmeriFlux sites, and evaluate potential biases as a consequence of the footprint-to-target-area mismatch. Monthly 80% footprint climatologies vary across sites and through time ranging four orders of magnitude from 103 to 107 m2 due to the measurement heights, underlying vegetation- and ground-surface characteristics, wind directions, and turbulent state of the atmosphere. Few eddy-covariance sites are located in a truly homogeneous landscape. Thus, the common model-data integration approaches that use a fixed-extent target area across sites introduce biases on the order of 4%–20% for EVI and 6%–20% for the dominant land cover percentage. These biases are site-specific functions of measurement heights, target area extents, and land-surface characteristics. We advocate that flux datasets need to be used with footprint awareness, especially in research and applications that benchmark against models and data products with explicit spatial information. We propose a simple representativeness index based on our evaluations that can be used as a guide to identify site-periods suitable for specific applications and to provide general guidance for data use.

Wetland methane (CH4) emissions ([Formula: see text]) are important in global carbon budgets and climate change assessments. Currently, [Formula: see text] projections rely on prescribed static temperature sensitivity that varies among biogeochemical models. Meta-analyses have proposed a consistent [Formula: see text] temperature dependence across spatial scales for use in models; however, site-level studies demonstrate that [Formula: see text] are often controlled by factors beyond temperature. Here, we evaluate the relationship between [Formula: see text] and temperature using observations from the FLUXNET-CH4 database. Measurements collected across the globe show substantial seasonal hysteresis between [Formula: see text] and temperature, suggesting larger [Formula: see text] sensitivity to temperature later in the frost-free season (about 77% of site-years). Results derived from a machine-learning model and several regression models highlight the importance of representing the large spatial and temporal variability within site-years and ecosystem types. Mechanistic advancements in biogeochemical model parameterization and detailed measurements in factors modulating CH4 production are thus needed to improve global CH4 budget assessments.

Methane (CH4) emissions from natural landscapes constitute roughly half of global CH4 contributions to the atmosphere, yet large uncertainties remain in the absolute magnitude and the seasonality of emission quantities and drivers. Eddy covariance (EC) measurements of CH4 flux are ideal for constraining ecosystem-scale CH4 emissions due to quasi-continuous and high-temporal-resolution CH4 flux measurements, coincident carbon dioxide, water, and energy flux measurements, lack of ecosystem disturbance, and increased availability of datasets over the last decade. Here, we (1) describe the newly published dataset, FLUXNET-CH4 Version 1.0, the first open-source global dataset of CH4 EC measurements (available at https://fluxnet.org/data/fluxnet-ch4-community-product/, last access: 7 April 2021). FLUXNET-CH4 includes half-hourly and daily gap-filled and non-gap-filled aggregated CH4 fluxes and meteorological data from 79 sites globally: 42 freshwater wetlands, 6 brackish and saline wetlands, 7 formerly drained ecosystems, 7 rice paddy sites, 2 lakes, and 15 uplands. Then, we (2) evaluate FLUXNET-CH4 representativeness for freshwater wetland coverage globally because the majority of sites in FLUXNET-CH4 Version 1.0 are freshwater wetlands which are a substantial source of total atmospheric CH4 emissions; and (3) we provide the first global estimates of the seasonal variability and seasonality predictors of freshwater wetland CH4 fluxes. Our representativeness analysis suggests that the freshwater wetland sites in the dataset cover global wetland bioclimatic attributes (encompassing energy, moisture, and vegetation-related parameters) in arctic, boreal, and temperate regions but only sparsely cover humid tropical regions. Seasonality metrics of wetland CH4 emissions vary considerably across latitudinal bands. In freshwater wetlands (except those between 20g g€¯S to 20g g€¯N) the spring onset of elevated CH4 emissions starts 3g€¯d earlier, and the CH4 emission season lasts 4g€¯d longer, for each degree Celsius increase in mean annual air temperature. On average, the spring onset of increasing CH4 emissions lags behind soil warming by 1 month, with very few sites experiencing increased CH4 emissions prior to the onset of soil warming. In contrast, roughly half of these sites experience the spring onset of rising CH4 emissions prior to the spring increase in gross primary productivity (GPP). The timing of peak summer CH4 emissions does not correlate with the timing for either peak summer temperature or peak GPP. Our results provide seasonality parameters for CH4 modeling and highlight seasonality metrics that cannot be predicted by temperature or GPP (i.e., seasonality of CH4 peak). FLUXNET-CH4 is a powerful new resource for diagnosing and understanding the role of terrestrial ecosystems and climate drivers in the global CH4 cycle, and future additions of sites in tropical ecosystems and site years of data collection will provide added value to this database. All seasonality parameters are available at 10.5281/zenodo.4672601 (Delwiche et al., 2021). Additionally, raw FLUXNET-CH4 data used to extract seasonality parameters can be downloaded from https://fluxnet.org/data/fluxnet-ch4-community-product/ (last access: 7 April 2021), and a complete list of the 79 individual site data DOIs is provided in Table 2 of this paper.

Seasonal phenological dynamics of vegetation hold important clues on ecosystem performance towards management goals, such as carbon uptake, and thus should be considered in projections of their targeted services. However, in wetlands spatio-temporal heterogeneity due to mixing of open water, soil, green and dead vegetation makes it difficult to generalize ecosystem functioning across different regions. Remote sensing observations can provide spatially-explicit, cost-effective phenology indicators; however, little is known about their capacity to indicate the links between wetland ecosystem structure and function. Here we assessed this potential by comparing one-year Enhanced Vegetation Index (EVI) from satellite products at high (5m; RapidEye) and low (30m; Landsat) spatial resolutions with eddy covariance time series of net carbon exchange, field digital camera (phenocam) greenness and water temperature among three floristically similar restored wetlands in California, USA. Phenological timing differed by wetland site: depending on satellite, the range in site-median start of greening was up to 28 days, end of greening – up to 73 days, start of senescence – up to 79 days, and end of senescence – up to 10 days. Key transition dates from satellite inputs agreed with seasonal changes in net carbon exchange, phenocam greenness and water temperatures, suggesting that phenological contrasts could result in part from site differences in vegetation configuration and litter affecting the exposure of canopy, soil and water to sunlight and thus sub-canopy microclimate and ecosystem functioning. Yet, the agreement between satellite inputs was non-systematic, with the greatest disparities at the more heterogeneous, less vegetated site. Phenological model fitting uncertainty increased with greater spatial resolution, highlighting the tradeoff between the accuracy of representing vegetation and the complexity of local seasonal variation. These findings highlight the sensitivity of satellite-derived phenology to structural and functional heterogeneity of ecosystems and call for more rigorous spatially-explicit analyses to inform assessments of restoration and management outcomes.

We describe a new coordination activity and initial results for a global synthesis of eddy covariance CH4 flux measurements.

Previous studies indicate that increased healthcare access through Medicaid expansion and alleviation of socioeconomic stressors via higher minimum wages improved health outcomes. This study investigates the spatial relationships between the Medicaid expansion, minimum wage policy, and Alzheimer's Disease (AD) dementia prevalence across the US. We used county-level AD dementia prevalence adjusted for age, sex, race/ethnicity, and education. Social Vulnerability Index (SVI) data, Medicaid expansion status, and state minimum wage law status were incorporated from CDC, Kaiser Family Foundation, and US Department of Labor sources, respectively. We employed the Getis-Ord Gi* statistic to identify hotspots and cold spots of AD dementia prevalence at the county level. We compared these locations with the overall SVI scores using univariate analyses. We also assessed the proportion of hot and cold spots at the state level based on Medicaid expansion and minimum wage status using the logistic regression model. The most vulnerable SVI quartile (Q4) had the highest number of hotspots (n = 311, 64.8%), while the least vulnerable quartile (Q1) had the fewest hotspots (n = 22, 4.6%) ( χ 2 = 307.41, p < 0.01). States that adopted Medicaid expansion had a significantly lower proportion of hotspots compared to non-adopting states (p < 0.05), and the non-adopting states had significantly higher odds of having hotspots than adopting states (OR = 2.58, 95% CI: 2.04–3.26, p < 0.001). Conversely, the non-adopting states had significantly lower odds of having cold spots compared to the adopting states (OR = 0.24, 95% CI: 0.19–0.32, p < 0.01). States with minimum wage levels at or below the federal level showed significantly higher odds of having hotspots than states with a minimum wage above the federal level (OR = 1.94, 95% CI: 1.51–2.49, p < 0.01). Our findings suggest significant disparities in AD dementia prevalence related to socioeconomic and policy factors and lay the groundwork for future causal analyses. [ABSTRACT FROM AUTHOR]

Wetlands can influence global climate via greenhouse gas (GHG) exchange of carbon dioxide (CO2 ), methane (CH4 ), and nitrous oxide (N2 O). Few studies have quantified the full GHG budget of wetlands due to the high spatial and temporal variability of fluxes. We report annual open-water diffusion and ebullition fluxes of CO2 , CH4 , and N2 O from a restored emergent marsh ecosystem. We combined these data with concurrent eddy-covariance measurements of whole-ecosystem CO2 and CH4 exchange to estimate GHG fluxes and associated radiative forcing effects for the whole wetland, and separately for open-water and vegetated cover types. Annual open-water CO2 , CH4 , and N2 O emissions were 915 ± 95 g C-CO2  m-2  yr-1 , 2.9 ± 0.5 g C-CH4  m-2  yr-1 , and 62 ± 17 mg N-N2 O m-2  yr-1 , respectively. Diffusion dominated open-water GHG transport, accounting for >99% of CO2 and N2 O emissions, and ~71% of CH4 emissions. Seasonality was minor for CO2 emissions, whereas CH4 and N2 O fluxes displayed strong and asynchronous seasonal dynamics. Notably, the overall radiative forcing of open-water fluxes (3.5 ± 0.3 kg CO2 -eq m-2  yr-1 ) exceeded that of vegetated zones (1.4 ± 0.4 kg CO2 -eq m-2  yr-1 ) due to high ecosystem respiration. After scaling results to the entire wetland using object-based cover classification of remote sensing imagery, net uptake of CO2 (-1.4 ± 0.6 kt CO2 -eq yr-1 ) did not offset CH4 emission (3.7 ± 0.03 kt CO2 -eq yr-1 ), producing an overall positive radiative forcing effect of 2.4 ± 0.3 kt CO2 -eq yr-1 . These results demonstrate clear effects of seasonality, spatial structure, and transport pathway on the magnitude and composition of wetland GHG emissions, and the efficacy of multiscale flux measurement to overcome challenges of wetland heterogeneity.

Methane (CH4) is a potent greenhouse gas (GHG) with atmospheric concentrations that have nearly tripled since pre‐industrial times. Wetlands account for a large share of global CH4 emissions, yet the magnitude and factors controlling CH4 fluxes in tidal wetlands remain uncertain. We synthesized CH4 flux data from 100 chamber and 9 eddy covariance (EC) sites across tidal marshes in the conterminous United States to assess controlling factors and improve predictions of CH4 emissions. This effort included creating an open‐source database of chamber‐based GHG fluxes (https://doi.org/10.25573/serc.14227085). Annual fluxes across chamber and EC sites averaged 26 ± 53 g CH4 m−2 year−1, with a median of 3.9 g CH4 m−2 year−1, and only 25% of sites exceeding 18 g CH4 m−2 year−1. The highest fluxes were observed at fresh‐oligohaline sites with daily maximum temperature normals (MATmax) above 25.6°C. These were followed by frequently inundated low and mid‐fresh‐oligohaline marshes with MATmax ≤25.6°C, and mesohaline sites with MATmax >19°C. Quantile regressions of paired chamber CH4 flux and porewater biogeochemistry revealed that the 90th percentile of fluxes fell below 5 ± 3 nmol m−2 s−1 at sulfate concentrations >4.7 ± 0.6 mM, porewater salinity >21 ± 2 psu, or surface water salinity >15 ± 3 psu. Across sites, salinity was the dominant predictor of annual CH4 fluxes, while within sites, temperature, gross primary productivity (GPP), and tidal height controlled variability at diel and seasonal scales. At the diel scale, GPP preceded temperature in importance for predicting CH4 flux changes, while the opposite was observed at the seasonal scale. Water levels influenced the timing and pathway of diel CH4 fluxes, with pulsed releases of stored CH4 at low to rising tide. This study provides data and methods to improve tidal marsh CH4 emission estimates, support blue carbon assessments, and refine national and global GHG inventories. [ABSTRACT FROM AUTHOR]

Background and Purpose: Several studies have established the efficacy of home health in meeting the health care needs of people with Alzheimer disease and related dementias (ADRD) and helping them to remain at home. However, transitioning to the community after discharge from home health presents challenges to patient safety and quality of life. The severity of an individual's functional impairments, cognitive limitations, and behavioral and psychological symptoms may compound these challenges. The purpose of this study was to examine the association between dementia severity and successful discharge to community (DTC) from home health. Methods: This was a retrospective study of 142 376 Medicare beneficiaries with ADRD. Successful DTC was defined as having no unplanned hospitalization or death within 30 days of DTC from home health. Successful DTC rates were calculated, and multilevel logistic regression was used to estimate the relative risk (RR) of successful DTC, by dementia severity category, adjusted for patient and clinical characteristics. Six dementia severity categories were identified using a crosswalk between items on the Outcome and Assessment Information Set and the Functional Assessment Staging Tool. Results and Discussion: Successful DTC occurred in 71.2% of beneficiaries. Beneficiaries in the 2 most severe dementia categories had significantly lower risk of successful DTC (category 6: RR = 0.90, 95% CI = 0.889-0.910; category 7: RR = 0.737, 95% CI = 0.704-0.770) than those in the least severe dementia category. The RR of successful DTC for people with ADRD decreased as the level of independence with oral medication management decreased and when there was an overall greater need for caregiver assistance. Conclusions: Patient status at the time of admission to home health is associated with outcomes after discharge from home health. Early identification of people in advanced stages of ADRD provides an opportunity to implement strategies to facilitate successful DTC while people are still receiving home care services. The severity of ADRD and availability of care-giver assistance should be key considerations in planning for successful DTC for people with ADRD. [ABSTRACT FROM AUTHOR]