United Hospital Fund Report Examines Hospital Patients’ Refusal of Home Care Services & the Impact on Readmissions and Outcomes
United Hospital Fund (UHF) and the Alliance for Home Health Quality and Innovation (the Alliance) today released a report titled, “I Can Take Care of Myself!”: Patients’ Refusals of Home Health Care Services, on the under-examined issue of patients who refuse home health care services when they are discharged from inpatient care. Such refusals can lead to higher rates of readmission to the hospital and a lower quality of life.
Although information on this complex issue is limited, a study by Kathyrn Bowles, PhD, of the Visiting Nurse Service of New York and the University of Pennsylvania, found that 28 percent of 495 eligible patients refused home health care services. Their reasons ranged from concerns about finances, to a fear of losing control and privacy, to the belief that family members could manage needed care on their own. Those who refused home health care were twice as likely as those who accepted to be readmitted to the hospital within 30 or 60 days.
These are just some of the findings contained in the report, which summarizes the discussion and findings of a December 2016 roundtable co-sponsored by UHF’s Families and Health Care Project and the Alliance. The 27 participants in the roundtable included clinicians, policy experts, and representatives of home health care agencies and consumer advocacy groups, who together worked to unravel the many factors surrounding a patient’s refusal, including personal choice, quality of care, and financing.
“As medical care increasingly moves from hospitals into the community, which for most people means care at home, the importance of home health care services in discharge planning is growing in importance,” said Carol Levine, director of UHF’s Families and Health Care Project and co-author of the report. “But there is little guidance for hospital staff on what to do when eligible patients refuse home health care.”
Teresa Lee, former Executive Director of the Alliance and also a co-author, said, “This report provides important insights for hospitals as they develop programs and practices that give patients the best care possible in their own homes.”
Among the roundtable findings contained in the report:
- Little is known about the process by which hospital staff identify patients for referral to home health care, how they explain these services, and how well they address the full range of patients’ and family caregivers’ transitional care needs.
- Patients and their family caregivers have similar goals, but may have different needs and attitudes about home health care.
- Policy and system barriers to accessing services include inflexible criteria for eligibility, inadequate payment for home health care agencies’ services for patients with complex conditions, and shortages of trained workforce.
The report contains a number of recommendations, among them interventions that improve communication about care challenges and home health care services, qualitative and quantitative research on all aspects of home health care refusals, policy changes to increase access and coordination, and continuity across providers and care settings.