Outcomes after Home Health Care among Four Racial/Ethnic Groups
Peng, Timothy R., Maryam Navaie-Waliser, Penny H. Feldman. Social Support, Home Health Service Use, and Outcomes Among Four Racial-Ethnic Groups. The Gerontologist 43(4): 503-513, 2003.

As the number of Americans living beyond 75 years of age skyrockets, more and more elderly are choosing home health care to meet their health needs rather than enter a nursing home. Not only is there a lack of research on health outcomes among elders using home health care, but few studies have included data on Hispanics and Asians--the most rapidly growing minority populations. For this study, the authors obtained data on White, Black, Hispanic, and Asian patients discharged to self-care or community care after receiving home health care from an agency in the urban Northeast, yielding over 7,000 study subjects. They compared physical and psychological functioning of the patients at admission to home health care and at discharge from care, as well as the presence of additional formal (paid) or informal care beyond that provided by the agency.

Certain trends were similar among all ethnic groups. Measures of physical function, including dependencies in activities of daily living (ADL) and instrumental activities of daily living (IADL), and percentage of patients reporting intractable pain improved between admission and discharge. Psychological functioning generally improved as well, with rates of anxiety, depression, confusion, and poor cognition decreasing among all ethnic groups. However, Whites were significantly more likely to report anxiety and depression at both admission and discharge, and Hispanics and Asians were more likely to have a greater number of IADL dependencies at discharge as compared to White or Black patients.

All ethnic groups showed a decrease in caregiver presence between admission and discharge, with an average of 15% reporting no caregiver at discharge, either formal or informal. This number was higher among Blacks, over 18%.

Implications for Social Work

The study's finding that a sizable number of elderly, particularly among Black patients, lack assistance upon discharge is cause for concern. Previous research shows that Black elders who lack social support are more likely to experience health problems and require long-term care. Although the physical condition of most patients had improved by discharge, they still faced significant physical hurdles, with three ADL and five IADL dependencies remaining on average. The authors recommend discharge planning for seniors with no supportive care available, focusing on community resources for assistance.

Although Whites were more likely than the other three groups to report anxiety and depression at admission and discharge, the strongest predictor of psychological problems at discharge was psychological problems at admission. This implies that home health care visits focused on improving physical functioning are unlikely to have a significant impact on pre-existing psychological issues.

The study highlighted the need for further research on outcomes upon discharge from home health care, such as factors likely to result in death or discharge to a hospital or nursing home rather than self-care or community care. The authors also recommend expansion of their work by exploring health outcomes among different racial groups in suburban and rural settings and in multiple states, as well as investigating possible disparities in quality of care between ethnic groups.

Posted on October 6, 2003