Examining Access to Home Health Care During Pandemic

In a recent study published in JAMA Network Open, researchers assessed patient access and utilization of home health care, post-hospital discharge. Results showed a number of barriers including socioeconomic disparities.

“As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care,” said Jun Li, PhD, department of health management and policy, School of Public Health, University of Michigan, Ann Arbor, MI, and colleagues.

The cross-sectional study analyzed 2,379,506 hospital discharges that included a home health care referral. Majority of patients were female (57%), 19.7% were nonwhite, median age was 73.9 years, and 19.6% were dually enrolled in Medicare and Medicaid.

Of the over two million patients included, only 54% received home health care services within 14 days of discharge, 37.7% never received
any home health care, and 8.3% were either institutionalized or died within 14 days post-discharge.

“Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges),” explained the researchers. “In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days).”

This data represents potential disparities in access to home health care which Dr Li and colleagues explained could have several potential explanations. One being that home health agencies might lack the necessary staff or resources to field all at home health referrals making them either unable or unwilling.

“There is a vast literature documenting that patients from racial/ethnic minority groups or socioeconomically disadvantaged backgrounds have worse access to care, even among fully insured patients,” noted Dr Li and colleagues in their study. “Home health agencies may view socioeconomically disadvantaged patients as overly complex to care for or may have a preference for serving higher socioeconomic status neighborhoods, resulting in lower rates of successful referral to home health among socioeconomically disadvantaged patients.”

Another potential reason for the low rates of home health care after referral could simply be patient preference. The researchers note that patients could believe the additional services are unnecessary and therefore do not follow through with the referral.

In the pandemic era, home health care presents a safer alternative to follow-ups after hospital discharge, but the researchers note that “The lower rates of home health visits among vulnerable patients is particularly troubling from an equity standpoint, where lower home health visits could contribute to disparities in health outcomes.”

Dr Li and colleagues also explained that the low rates of successful home health referral could even lead to increased readmission rates and further disparities, which could result in higher costs to health systems. —Edan Stanley