Achieving health equity through home care: The HCR African-American initiative

Issue: African-Americans access and utilize home health care services at lower rates than others, even though they experience disproportionately high rates of chronic diseases such as diabetes and hypertension that can be mitigated by such services. This underutilization of home care persists even when African Americans are insured and eligible for services.

Description: Using transcultural nursing concepts, Home Care of Rochester (HCR) developed an African-American Initiative in 2009 to improve the access, utilization and outcomes of home health care services for African-American patients. This demonstration project was modeled after HCR's successful Latino initiative and sought to broaden and deepen the organization's overall level of cultural competence.

Lessons Learned: An expert community advisory board and dedicated African-American health care team, lead by a registered nurse and community outreach worker, were pivotal to the success of the initiative. While the number of African-Americans served increased (from 156 to 192) because of the initiative, the model is not sustainable long-term because of costs related to staffing and the un-reimbursable social support/outreach services needed. Gaining the trust of African-Americans who are wary of the health care system, and who feel both disenfranchised and medically fatalistic was a major obstacle. Relationship building was key to the success of the initiative.

Recommendations: Insurance reimbursement and policy changes must be made to better support the staffing and social supports necessary to improve access, utilization and outcomes of home health care by African-Americans. Home care agencies should invest in improving the cultural competence of their organizations.