A new study supported by the National Institute on Aging has found that patients belonging to minority race populations show less functional improvement as a result of home health than white patients.

“Understanding how inequities are created and maintained is important for understanding how we can advance equity in the home health care setting,” lead researcher Shekinah Fashaw-Walters said.

To achieve this understanding, the University of Minnesota team used data from the 2016-2017 Outcome and Assessment Information Set, the Medicare Beneficiary Summary File and census data. Among a sample of more than 3 million people, the greatest proportion of patients experiencing functional improvement was found in white people, at 79%, followed by 76% of Asians and Pacific Islanders, 72% of Black people and Native Americans, and 70% of Hispanic people.

The results also showed that Black, Hispanic and Native American home health patients were more likely to be discharged without experiencing any functional improvement, and that higher-income people in general had better access to better-quality home healthcare than lower-income individuals. Even within the same home health agency, lower-income patients, on average, experienced less functional improvement than higher-income patients at the same provider.

Those findings were attributed in part to the accessibility of high-quality home care. White and higher-income patients typically have better access to higher-quality providers, Fashaw-Walters said, which often is a result of structural or institutional racism such as redlining.

The researchers recommend strategies to minimize inequities among home health patients, such as improving providers that serve a greater proportion of marginalized groups, using incentives to encourage health equity and training staff on socially-conscious care delivery. 

“Inequities are not created equally,” Fashaw-Walters said. “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.”