Commonwealth Fund Report Highlights Racial Disparity in Home Health Care

Last week, the Commonwealth Fund reported on a new survey that found that Medicare beneficiaries of color used more home health services than white beneficiaries overall and were more likely to rely on unpaid informal caregivers for those services.

Many older adults and people with disabilities require home health care services, including people who have post-acute needs – care after a hospitalization or injury – and those who manage chronic health conditions. Prior research has shown that Black and Hispanic Medicare beneficiaries who use home health services are more likely than their white counterparts to have poor health outcomes, including emergency department visits and hospitalizations. It has also shown an association between such outcomes, including an increased risk of mortality for older adults and higher use of low-quality home health agencies and informal caregivers. These studies indicate that the source of home health care may impact health outcomes. The Commonwealth Fund analyzed a nationally representative survey of Medicare beneficiaries to assess whether there was an association between the type of home health care provider – professional or informal – and the race and ethnicity of beneficiaries.

They found that Black and Hispanic individuals used home care services at higher rates and were more likely to rely on informal providers, often family and friends. The report also references other studies that show that access to consistent in-home services can be difficult to obtain because of misunderstandings about the Medicare home health benefit, frequent misinformation from home health agencies and providers, and narrow interpretations of the benefit. These barriers may be greater for Medicare beneficiaries of color who may be less likely to be able to pay out-of-pocket for services, as the median per capita savings among white Medicare beneficiaries is more than six times the savings accumulated among by Black or Hispanic beneficiaries. 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 report concludes that “Ensuring that Medicare beneficiaries have equitable access to high-quality home health care providers merits greater attention. The Medicare home health benefit is not adequately addressing the needs of its beneficiaries in sufficiently lowering access barriers to the highest quality of in-home services and supports. It will be important to further explore the different types of in-home providers used across racial and ethnic groups in the Medicare population and the quality of care they can provide, as well as the reasons why certain groups have worse health outcomes than others.”

Read a summary of the report.