New research finds Black patients less likely to receive home health care after hospitalization

A new study found patients who are Black were less likely to receive home health care after a hospital stay compared to patients of other races.

Abiola Keller, associate professor at Marquette University’s College of Nursing, looked at data from more than 14,000 Medicare patients at 31 hospitals in the U.S.

When patients no longer need hospital-level care, a provider assesses their readiness for discharge and gives them a score. Keller said a comparison of these scores did not find a difference in the way patients were being assessed. But Black patients had to score worse than patients who were white in order to have the same likelihood of receiving a home health care referral.

She said the finding was “shocking, but not surprising” given the well-documented racial disparities in the health care system that have led to worse outcomes for Black patients.

“It’s a continued call to action, that we cannot stop looking for evidence for this because we know it exists,” Keller said. “Looking at it specifically in home health care referrals is really important because we know that Black patients are more likely to die at a younger age. So perhaps if we can intervene here and level the playing field a little bit, we can actually prevent some of those early deaths.”

Overall, the research found that 22 percent of Black patients left the hospital with a home health referral compared to 27 percent of white patients.

The differences in referrals were highest for patients with the lowest discharge scores, with 27 percent referral rates for Black patients and 33 percent for white patients who scored a six or lower on the 10-point readiness scale.

The study did not find the same type of disparity for Hispanic patients or other non-white patients. Keller said more research is needed to understand what factors are leading to these differences. But one factor could be the complicated history that African Americans have with the healthcare system.

“Home health care, for some patients, is perceived as an extension of the health care system so there just might be a lower level of trust,” she said. “The referral could have been given and the patient declined. So we need to do more work to understand that.”

Keller said if that is the case, health care providers have a responsibility to understand why people are refusing and to improve the way they are communicating with patients and their families.

She said the research highlights the importance of understanding the lived experiences of patients in order to address the root causes of health issues.

“Even in our best intentions of trying to address that, our solutions will be less than effective if we don’t truly understand what patients need and want in real time,” she said.