Home Health & Hospice Week

Plus: Two more recent studies address health equity issues.

Law- and policymakers need to take a look at the big picture before hollowing out the hospice benefit. So suggests a new study published in Health Affairs.

“For community-dwelling people with dementia, Medicare costs were lower for those who used hospice than for those who did not, whether hospice enrollment was in the last three days ($2,200) or last three months ($7,200) of life,” says the abstract for the study, Health Care Costs Associated With Hospice Use For People With Dementia In The US.

Even “in nursing homes, total and Medicare costs were lower for hospice users with dementia who enrolled within a month of death than for those who did not use hospice,” say the researchers from the Icahn School of Medicine at Mount Sinai and University of California San Francisco.

“Policymakers in the U.S. are increasingly concerned that greater use of the Medicare hospice benefit by people with dementia is driving up costs. Yet this perspective fails to incorporate potential cost savings associated with hospice,” the authors say. “Medicare policies that reduce hospice access and incentivize hospice disenrollment may actually increase Medicare costs, given that hospice cost savings generally derive from a person’s last days or weeks of life,” they warn.

The abstract is online at www.healthaffairs.org/doi/ abs/10.1377/hlthaff.2023.00036.

Meanwhile, two other recent home health studies tackle health equity issues:

• Study No. 1: A study from the University of Minnesota School of Public Health found differences in functional improvement for home health patients based on race, ethnicity, and income status, according to a UM release. Using OASIS and other data for 2016-2017, researchers found the percentage of patients with functional improvement was 79 percent for White and higher-income patients, 76 percent for Asian-American/Pacific Islander patients, 72 percent for Black and American Indian/Alaska Native patients, 71 percent for low-income patients and 70 percent for Hispanic patients.

“Understanding how inequities are created and maintained is important for understanding how we can advance equity in the home health care setting,” says SPH Assistant Professor and lead researcher Shekinah Fashaw- Walters in the release. “Inequities are not created equally — to create change for most racial and ethnically minoritized home health patients we have to focus on improving access to higher quality agencies; but for lower-income home health patients we have to focus on making sure they are receiving equitable treatment within each agency,” she adds.

The study abstract is at https://pubmed.ncbi.nlm.nih. gov/37356822/.

• Study No. 2: Researchers from New York University and other institutions examined whether continuity of staff and having staff that spoke the patients’ language decreased hospital readmissions for home health patients.

“High continuity of care and high language concordance significantly decreased readmissions,” the authors conclude in the abstract. “However, having the same nurse across home care visits, even if they didn’t speak the same language as the patient, was also linked to lower hospital readmissions,” according to an NYU release. In contrast, “low continuity of care and high language concordance did not significantly impact readmissions,” the abstract notes.

“While having both the continuity of the same nurse across multiple visits and a nurse who speaks the same language as the patient is ideal, enhancing continuity of care for those where there is language discordance between themselves and the health care provider may be helpful to address disparities and reduce hospital readmission rates,” RN Allison Squires, associate professor at NYU Rory Meyers College of Nursing and the study’s lead author, says in the release.

However, “achieving continuity of care is only possible if a home care organization is able to recruit and retain nurses,” Squires acknowledges in the release. The abstract is at https:// pubmed.ncbi.nlm.nih.gov/37561604/.