Home health services are a vital component of care continuity. But nurses are less likely to give Black patients, compared to white patients, home health referrals when being discharged from a hospital stay, a new University of Michigan study found.
Specifically, researchers found that roughly 22% of Black patients were receiving home health referrals by discharge nurses, compared to 27% of white patients.
“It raises the signal that there is this group of patients, primarily black patients, who may not be receiving this essential service that is referrals for home health care,” Abiola Keller, associate professor of nursing at Marquette University, and co-author of the study, told Home Health Care News. “It calls us to ask further questions about why this might be, and how we make sure that all patients have equitable access to the services.”
The study also found that Black patients that had high risk factors for hospital readmission, such as living alone and multiple chronic conditions, were regularly marked down as equally ready for hospital discharge as white patients, and higher than other ethnic groups.
In fact, Black patients needed to score two points more on their discharge assessment to have the same chance at receiving a referral to home health as white patients.
Additionally, the study found that Black patients had a higher readmission rate, checking in at 15%, compared to 10% for white patients, 13% for Hispanic patients and 12% for other groups.
“Across the board, Black individuals are more likely to die prematurely,” Keller said. “If the goal is to advance the health and wellbeing of our nation, then we need to start looking at what are some of the levers that we can pull, especially for Medicare patients.”
The findings in this latest University of Michigan study are not the first of its kind.
In 2022, researchers found racial, ethnic and socioeconomic inequities that resulted in less access to high-quality home health care services for Medicare patients, according to a study published in Health Affairs.
Plus, Black patients had a lower probability of utilizing a high-quality home health agency, according to the study.
“Before our study, there have been other studies that did show that racial and ethnic minority patients were less likely to receive home health care,” Keller said. “What’s unique about our study is that we looked at how nurse assessment of the patient’s readiness for discharge affected whether or not they received a referral from home health services.”
Ultimately, Keller believes there are steps that can be taken to begin to address these barriers to care issues.
“I think the first step is increasing education across the board, for health care providers, patients and families about the role of home health and what can and cannot be done,” she said. “When we think about health equity, we can’t disregard the importance of trust in our health care institutions. That might be one of the issues that is also at play here. For [home health] executives, one thing I always ask is, ‘How are you showing up in your communities that you serve? Are you showing up at the places where they’re at, so they know who you are before they need your services?’”