Many older adults do not receive home health care despite referrals

Many older adults who are referred to home health care after hospitalization do not receive it, with Black and Hispanic patients receiving lower rates of care, according to research published in JAMA Network Open.

“Home health care helps patients return to prior levels of functioning, gain independence and remain in the community,” Jun Li, PhD, assistant professor of public administration and international affairs at the the Maxwell School of Citizenship and Public Affairs at Syracuse University, told Healio Primary Care. “Prior research indicates that home health care is also associated with lower total post-discharge spending. Having a significant portion of the population, particularly those who are more disadvantaged, not be getting the care that they need may mean that these patients have worse health outcomes in the long-run.”

Li and colleagues conducted a cross-sectional study of Medicare data on post-acute home health care settings involving Medicare fee-for-service and Medicare Advantage beneficiaries from October 2015 through September 2016. Participants were referred to home health care after hospital discharge.

A total of 2,379,506 discharges with home health care referrals were evaluated in the study. The mean age of those included in the study was 73.9 years, and they had 4.1 Elixhauser comorbidities.

Li and colleagues found that only 54% of patients who were discharged with a home health care referral received these services within 2 weeks. Among other patients, 37.7% never received home health care and 8.3% were institutionalized or died within 2 weeks without having received a home health care visit.

The researchers observed lower rates of home health care after referral among Black (48%; 95% CI, 47.8%-48.1%) and Hispanic (46.1%; 95% CI, 45.7%-46.5%) patients who were discharged compared with white patients who were discharged (55.3%; 95% CI; 55.2%-55.4%).

Among patients who did receive a home health care visit, those in disadvantaged areas waited longer for their first visit. For instance, patients who lived in ZIP codes with higher unemployment rates waited a mean of 2 days (95% CI, 2.0-2.0 days) for their first visit, while those who lived in ZIP codes with low unemployment waited a mean of 1.8 days (95%CI, 1.8-1.8 days).

Li said the study did not investigate the reason for lower home health care visits among Black and Hispanic patients, but hospital staff told researchers that some patients refused care, possibly due to privacy concerns and patients not wanting staff to enter their homes, not understanding the value of these services or forgetting that they agreed to these referrals in the “chaos” of leaving the hospital.

She added that staff at many hospitals said there is a lack of follow up with patients who were given referrals for home health care.

“Among those who do follow up with patients, it appears that, at least anecdotally, discharge planners can help patients recognize the importance of home health care,” Li said. “Primary care physicians can play an important role here by following up with patients to see if they are getting the care that they need.”