Community-based health: Promoting equity in Medicare home health care

Home health care plays a pivotal role in enabling older adults to remain in their homes/community or to transition back to the community after hospitalization. Home health care goals include: stabilization, rehabilitation, and health improvement. However, not all home health care recipients benefit equally from home health care. In particular, recent studies indicate disparate outcomes for minority recipients of home health care. In order to explore what might be contributing to these disparate outcomes, we conducted focus group interviews with various types of home health care staff from a variety of agencies in a diverse metropolitan area. These qualitative findings highlight several themes discussed by staff including patient, practice, agency and system factors that they felt influence outcomes by race/ethnicity. In particular, this presentation reports on the staff's perspectives on: agency level factors such as policies and procedures related to cost control, coverage issues and staffing assignments; and system factors including health care access, costs, insurance issues, and the culture of health care. Staff respondents suggest a mediation path in that agency and system factors may affect either access to care, and/or the quality (e.g. lack of consistency) of the care provided which then impact patient outcomes. We relate these results to both theoretical frameworks and existing empirical understanding of this complex problem to inform the development of a more equitable system of home health care delivery.