Same Home Care Nurse May Cut Hospital Readmissions for LEP Patients

Organizations looking to cut down on hospital readmissions among their limited English proficiency (LEP) populations getting home-based care may consider deploying the same nurse for every visit, according to new data from the NYU Rory Meyers College of Nursing.

This study, published in the journal Medical Care, outlines how care continuity and longitudinal patient-provider relationships can improve outcomes and help overcome some language barriers even when optimized staffing—either a multilingual nursing staff or staffing medical interpreters—isn’t possible.

Home-based care has grown more popular as healthcare organizations embrace value-based care contracts and begin to prioritize patient-centered healthcare experiences. Most patients want to recover from an inpatient hospitalization at home, and home-based care can achieve good outcomes at a lower cost.

But those good outcomes aren’t true for every population, the NYU researchers said. Patients with limited English proficiency have a higher risk for hospital readmission, the researchers said, citing 2021 data from NYU. This is often because language barriers can hamper patient-provider communication and therefore get in the way of quality healthcare.

Ideally, healthcare organizations would be able to hire a diverse team to administer home-based care. Having healthcare providers who can speak multiple languages increases the odds of language concurrence when a nurse visits LEP patients.

“Home care agencies should aim to hire and retain nurses that speak the same languages as their patients, but realistically, there are not enough nurses to meet this demand,” Allison Squires, PhD, RN, FAAN, associate professor at NYU Rory Meyers College of Nursing and the study’s lead author, said in a statement emailed to press.

This latest assessment offers some actionable insight that healthcare organizations can take now amid a nursing workforce shortage, Squires indicated. Even if language concordance isn’t possible with an organization’s home-based nursing team, providers can support good outcomes by ensuring care continuity, or making sure the same nurse visits with the patient for all home health visits.

The research team looked at 22,103 patients who received home-based nursing care after an acute inpatient hospitalization. Patients spoke Spanish, Korean, Chinese, or Russian as their primary language.

Unsurprisingly, patients who experienced continuity of care and language concordance with their nurse provider saw the lowest risk of hospital readmission. Conversely, having different nurses throughout the home care journey resulted in a higher risk of hospital readmission.

But notably, having the same nurse across all home care visits, even when that nurse did not speak the same language as the patient, also resulted in a lower risk of hospital readmission, albeit lower than when there was language concordance.

“It is thought that the more often a nurse interacts with a patient, the more likely they are to get to know them and their family or caregivers, regardless of whether there is a language barrier,” Squires explained.

Squires and her team indicated that this data could pave a path forward for hospitals that want to reduce hospital readmissions but who can’t necessarily hire or train a language-diverse home health workforce.

“For providers referring patients to home health care services and coordinating these referrals, it may be worth considering an agency’s ability to support continuity of skilled nursing care to reduce the odds of hospital readmission,” Squires recommended. “Home health care organizations should assign providers with an eye towards ensuring that a patient’s preferred nurse can remain involved in their treatment throughout their care.”

Still, ensuring care continuity has its own complications, especially in the industry’s fraught workforce challenges. Nursing job satisfaction is on the outs, and the workforce is dwindling, reports have shown. According to the researchers, many organizations have to rely on per-diem workers, so it can be hard to assign a single nurse to a home health patient throughout the whole home healthcare journey.

“Achieving continuity of care is only possible if a home care organization is able to recruit and retain nurses,” Squires noted.