Significant disparities identified for minorities using home health care, MU study finds

Minorities at greater risk of rehospitalization and ER visits

May 7th, 2018

COLUMBIA, Mo. – Approximately 12 million people in the U.S. make use of home health care, most of them older adults. Home health care allows people to be treated and monitored for a variety of health conditions from the comfort of their homes, often following major surgeries or hospitalizations. Now, researchers at the University of Missouri have found that, for older adults receiving home health care after a hospitalization, racial and ethnic minority groups may be at greater risk of rehospitalization and emergency room (ER) use compared to non-Hispanic whites.

“Home health care is generally very beneficial for older adults,” said Jo-Ana Chase, an assistant professor in MU’s Sinclair School of Nursing. “We have seen that it leads to lower rates of both rehospitalization and ER use. But no one had really looked at whether there are racial or ethnic disparities in those benefits. We found that elders from racial and ethnic minority groups, especially African-Americans, had much higher rates of re-hospitalization and ER visits.”

Chase and her colleagues analyzed data from a racially and ethnically diverse sample of home health care recipients in New York, all of whom were Medicare recipients age 65 or older who had been hospitalized prior to their home health care episode. They found that African-Americans were by far the most at-risk group, as they were 45 percent more likely to visit the ER and 34 percent more likely to be rehospitalized compared to non-Hispanic whites. Additionally, Hispanic older adults had a 26 percent higher likelihood of an ER visit compared to non-Hispanic whites.

Researchers found that individual factors—largely clinical concerns, such as the severity of a patient’s illness, their ability to perform daily activities, and the presence of conditions such as incontinence—only accounted for 4 percent of this disparity. In other words, about 96 percent of the racial and ethnic differences observed could not be explained by individual differences in health. On the heels of previous research suggesting minorities are receiving fewer types of home health care services despite greater need, Chase said the next stage of research should investigate the quality of home health care and the types of services diverse elders may receive.

“Caregivers and the agencies that provide this care are an important piece of the equation,” Chase said. “Now that we know the specifics of an individual’s health explain a small proportion of what we observed, it’s important to research other factors that may be involved, such as how these patients’ care needs are being met by home care agencies, clinicians and caregivers.”

For now, the results of the study can be used to form risk-assessment tools to help clinicians and caregivers better understand the needs and risk factors of their patients, Chase said.

The study, “Relationships between race/ethnicity and health care utilization among older post-acute home health care patients,” was published in the Journal of Applied Gerontology. Funding was provided in part by the National Institutes of Health (T32NR009356). Other researchers involved in the study were Liming Huang, Alexandra Hanlon and Kathryn H. Bowles of the University of Pennsylvania; David Russell of Appalachian State University; and Melissa O’Connor of Villanova University.