UNDERSTANDING RACIAL AND ETHNIC DISPARITIES IN HOME HEALTH CARE: PRACTICE AND POLICY FACTORS

Understanding racial/ethnic disparities in home health is essential both ethically and for advancing the overall health of the population, thereby reducing costs from morbidity and mortality. Equitable distribution of home health services is also critical to aging in place. A mixed methods study was conducted to understand the contributing factors to home care outcome disparities. Utilizing existing Medicare data from the Outcome ASsessment Information Set (OASIS), and Provider of Services file, we tested the hypothesis that minority home care patients would have lower functional status at discharge compared to white patients. Multivariate regression procedures were used on composite measures of activities and instrumental activities of daily living. We also conducted focus group interviews with a convenience sample of 23 home health agency staff recruited from a tri-state region. The focus groups explored staff’s intimate perspectives on caring for the elderly in their homes and the complex practice factors that contribute to disparate health outcomes. Quantitative analyses demonstrated that minority home health recipients experienced greater deterioration in functional status during their home health episode relative to white patients. In focus groups, staff reported patient (e.g. health literacy, income), staff (e.g. staff discretion, bias), agency (e.g. lack of staff diversity, cost control practices), and system factors (e.g. insurance coverage, reimbursement cuts,) which influence the relationship between race/ethnicity and outcomes. Results highlight the relationship between access to care, quality care and outcomes. Staff discretion, bias and institutional forms of racism may contribute to disparities in functional status for minority home health care recipients.