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Home Health Care

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Nearly half of home health care clients have unmet needs such as household and nutritional support

In order for people using home health services to remain alone in their homes without family or other informal support, they often need nutritional support, help with household chores, and/or other formal services to supplement medical and nursing care. These services may be the key that enables a person to use home care rather than institutional care. Yet nearly half of home health care clients receive only some or none of the support services they need, according to a study supported in part by the Agency for Health Care Policy and Research (HS06843).

Typically, support services are not provided because they are not reimbursable, the demand for some services outweighs supply, physicians writing home care orders are not aware of all their patients' needs, and/or hospital discharge planners have not arranged for the correct mix of support services. Certain patient factors decrease the likelihood that adequate care will be provided. These include being black or a member of another minority group, having Medicaid insurance, being in a health maintenance organization, having AIDS, and receiving maternal/child health services.

Cindy Parks Thomas, P.A., M.S., of Brandeis University, and Susan M. Payne, Ph.D., of Case Western Reserve University, collected data from 2,013 home health clients of 12 nonprofit agencies in Massachusetts in 1993 to examine client-related factors associated with the need for formal support services and factors associated with whether those needs were adequately met. They asked the visiting nurse to identify unmet need for support services. Overall, 85 percent of clients needed one or more support services. Nearly half of the home health clients were not receiving enough support to meet all of their needs. Of those with any unmet need, over 80 percent needed three or more services that were not being provided. If the home health visit was a hospital admission visit or the patient had an acute condition, the need for support services was less likely to be met than if the patient was an ongoing client. The services with the highest level of unmet need were mental health, with 56 percent not receiving needed services, social work (45 percent), and speech therapy (51 percent).

Details are in "Home alone: Unmet need for formal support services among home health clients," by Ms. Thomas and Dr. Payne, in the Home Health Care Services Quarterly 17(2), pp. 1-20, 1998.

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