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Home Health Care Increasing; Significant Geographic Variation Identified, Study Finds

March 31, 2017
by Jennifer Kaylin

The availability of home health care increased nationwide from 2002 to 2015, but there is still significant geographic variation that may affect accessibility for consumers, a new study coauthored by the Yale School of Public Health finds.

Researchers found that the west, northeast and south Atlantic regions of the United States had lower home health care availability than the central regions. Researchers also found that regions with a higher median income, a larger senior population, more households without a car, reduced access to stores, greater rates of obesity, greater inactivity and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care.

Post-acute care has become an important target for quality improvement and patient-centered care in the United States. Better post-acute care can benefit patients in many ways, including shorter hospital stays, reduced cost and fewer readmissions, said Associate Professor Judith Lichtman, Ph.D., senior author of the paper and chair of the Department of Chronic Disease Epidemiology at Yale.

“As home health care becomes a more important component of the U.S. healthcare system, it is important to understand whether these services are available across the country,” Lichtman said. “Identifying regional gaps in service can inform future healthcare planning for our aging society.”

Yale researchers and their colleagues launched a comprehensive investigation of the trends in the availability of home health care across the United States, surveying 15,184 Medicare-certified home health agencies, serving 97 percent of U.S. ZIP codes. Participants were all Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system. The study is published in the Journal of the American Geriatrics Society.

Home health agencies provide skilled nursing care, physical, occupational and speech therapies, social work services and assistance with activities of daily living to homebound patients, thereby playing an important role in the delivery of post-acute care. The number of Medicare-certified home health agencies has increased during the last decade, from roughly 7,500 in 2000 to more than 12,000 in 2015. The number of patients rose from 2.5 million in 2000 to 3.5 million in 2013, with nearly 123 million visits. Medicare paid nearly $28 billion for these services.

Identifying regional gaps in service can inform future healthcare planning for our aging society.

Judith Lichtman

The researchers found a slight increase in the availability of home health care from 2002-2003 through 2014-2015, which was accompanied by a reduction in the number of ZIP codes without home health care. But they also found much geographic variation in home health care accessibility.

With the number of U.S. seniors projected to grow from 45 million in 2015 to 84 million in 2050, “the provision of high-quality home-based care across all geographic areas will become an important component of the U.S. healthcare system in coming years,” Lichtman said. “The persistent variation in the availability of home health care nationwide highlights opportunities to expand future services to improve care of the aging population.”

Home health care has been emphasized under the Improving Medicare Post-Acute Care Transformation Act of 2014 to provide and improve care for individual patients and for communities.

Erica Leifheit-Limson, Ph.D., YSPH associate research scientist, collaborated on the study along with researchers from the Harvard T.H. Chan School of Public Health, Yale University, Yale-New Haven Hospital, Norwalk Hospital, Whitney Center in Hamden, Conn., University of New Hampshire and Qualidigm in Wethersfield, Conn.

Submitted by Denise Meyer on March 31, 2017