Black, Hispanic and low-income patients face a little-known care gap

Black, Hispanic and low-income patients on Medicare have less access to high-quality home health agencies, according to new research. The same is true for those who live in neighborhoods with a greater share of Black, Hispanic and low-income residents.

A new Health Affairs study found that there is 5.5 percentage points between Black and white patients' use of high-quality home health agencies, 11.9 percentage points between Hispanic and white patients' use and a 3.9 percentage-point difference between higher-income and low-income patients' use, making high-quality care "out of reach" for some. More than 3 million Medicare beneficiaries receive home health services.

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Dr. Shekinah Fashaw-Walters, one of the authors of the report and an assistant professor at the University of Minnesota in the health policy and management division, said she hopes the study serves as a "call to action" as the home health industry grows and develops.

"I think it's important to keep equity in the forefront and be really proactive at it," Fashaw-Walters said. "I'm hoping policymakers and administrators will see this work and realize something needs to be done."

And that means going beyond just throwing money at home health agencies, she said. Moving forward involves making sure high-quality agencies know how to reach and serve marginalized populations, she said.

"I think one of the pieces that really hit home for me was finding that a meaningful amount of the disparity we saw was really driven by neighborhood characteristics," Fashaw-Walters said. "That was eye opening."

More people in the home health space have started having discussions about disparities in care, which Bill Dombi, president of the National Association for Home Care and Hospice, called a "good movement forward."

He warned against jumping to conclusions about the cause of inequities in care though. Some populations only want to be cared for by members of their community and others have cultural differences that make them less likely to invite someone into their home when they're sick, Dombi said.

CMS Quality of Patient Care star ratings are "problematic" and don't always accurately reflect the quality of a home health agency, he added.

"A three-star agency can be an inch away from the quality of a five-star agency," Dombi said.

Yet, despite the hurdles to addressing disparities, "there is enough data out there to say this deserves investigation," Dombi said.

For its part, the National Association for Home Care and Hospice in 2020 launched a diversity and inclusion task force to determine if they have "a racially imbalanced set of owners," Dombi said.