Unequal Home Healthcare Agency Access Yields Racial Health Disparities

Medicare beneficiaries of color are more likely to use unpaid, informal caregivers, like family caregivers, for their home healthcare than White beneficiaries, a trend researchers from the Commonwealth Fund said likely contributes to the poorer health outcomes experienced by home healthcare recipients of color.

These findings come as the medical industry turns its attention toward home healthcare. Home healthcare can be a patient satisfier because it allows individuals to recover and rehabilitate after an acute care episode in their own homes rather than in a skilled nursing facility.

But home healthcare also raises new questions about workforce, as it relies on the services of home healthcare providers. In some cases, those home healthcare providers are unpaid, informal caregivers like family members looking after their loved ones.

The Commonwealth Fund researchers pointed out a link between home healthcare providers and the clinical outcomes of their patients. People receiving care from low-rated home healthcare agencies tend to see more adverse outcomes, while there is also an increased risk of mortality for those primarily getting their home healthcare from informal, unpaid caregivers.

Through an analysis of the Agency for Healthcare Research and Quality’s (AHRQ’s) Medical Expenditure Panel Survey, the researchers found that non-Hispanic Black and Hispanic people are more likely to lean on unpaid, informal caregivers than higher-quality home healthcare agencies.

Medicare beneficiaries of color used home healthcare providers for around seven months a year, the researchers said. For Hispanic people, the total number of days receiving home healthcare totaled 340, and for Black people, that figure was 227.

Hispanic people received their home healthcare from an informal, unpaid caregiver for 166 days and Black people received their home healthcare from an informal caregiver for 124 days. Both racial groups were more likely to use an unpaid, informal caregiver than an agency home healthcare provider.

White people, who needed only about 5 months of home healthcare overall, were about equally as likely to use unpaid caregivers than agency caregivers.

The disparity in agency home healthcare provider access may be lending itself to disparities in home healthcare outcomes, the Commonwealth Fund researchers said. Black and Hispanic people receiving home healthcare face a higher likelihood of emergency department visits and hospitalization, the researchers said, citing data published in the Journal of Applied Gerontology.

This is likely because providing home healthcare is a full-time job, and family caregivers and other unpaid or informal caregivers need to balance it with other responsibilities, the researchers posited.

“Lack of proper training for such caregiving can place a significant responsibility on the individuals receiving care and those caring for them,” the researchers explained. “The greater overall use of such home health care services by Medicare beneficiaries of color suggests that these populations may face more challenges managing their health at home and potentially have worse outcomes, with a greater burden on friends and family.”

The researchers indicated that cost is the primary barrier to home healthcare agency access. Citing 2019 figures from the Centers for Medicare and Medicaid Services (CMS), the Commonwealth Fund researchers pointed out that White Medicare beneficiaries have around 6 times the per-capita savings than Black and Hispanic beneficiaries.

This leaves some beneficiaries of color with few options after an acute care episode.

“When beneficiaries do not have the resources to pay out-of-pocket for services, patients and families can be forced to pay for services themselves, as much as finances allow; fend for themselves; or go without needed care,” the researchers explained.

There may also be some patient navigation issues at hand, with the Commonwealth Fund researchers referencing previous qualitative data showing that lack of knowledge about Medicare home healthcare benefits and narrow benefits design getting in the way of access.

“Ensuring that Medicare beneficiaries have equitable access to high-quality home health care providers merits greater attention,” the researchers concluded. “Medicare plays a pivotal role as a safety net for older U.S. adults. Targeting policies to reduce health disparities among the aging in Medicare could subsequently have a profound effect.”