Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults

Importance Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. Objective To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. Design, Setting, and Participants This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2379506 discharges). Statistical analysis was performed from July 2019 to June 2020. Exposures Hospital referral to home health care. Main Outcomes and Measures Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. Results Among 2379506 discharges from the hospital with a home health care referral, 135697 patients (57.1%) were female, 468762 (19.7%) were non-White, and 466383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 12300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1095206 patients (46.0%) discharged, 37.7% (896660 discharges) never received any home health care, while 8.3% (198546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). Conclusions and Relevance Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care. Question How often do Medicare patients referred to home health care at hospital discharge receive a home health care visit, and are there disparities? Findings In this cross-sectional study of Medicare beneficiaries in 2016, only 54.0% of patients discharged from the hospital with a home health care referral received home health care services within 14 days of discharge. This rate was even lower among Black and Hispanic patients, those who were dually enrolled in both Medicare and Medicaid, and patients who lived in high-poverty, high-unemployment zip codes. Meaning These findings suggest that patients may face important differential barriers in access to home health care. This cross-sectional study examines Medicare patients who were discharged from the hospital with a home health care referral in 2016 and the rates at which home health care was actually received.