Patients Who Refuse Home Health More Likely to be Readmitted

By Amy Baxter, Home Health Care News

Patients who refuse home health care services following a hospital discharge may be at higher risk of being readmitted, according to study findings cited in a recent report from the Alliance for Home Health Quality and Innovation and the United Hospital Fund (UHF).

The report, “I Can Take Care of Myself! Patients’ Refusals of Home Health Care Services,” cited findings brought up in a roundtable discussion on why patients turn down services and the impact of those decisions.

In one study of 30- and 60-day readmissions in New York City and Philadelphia, 28% of the 495 participants who were offered home health care services refused them. Patients who refused services were generally healthier and younger than those who accepted, but they were also twice as likely to end up back in the hospital within 30 or 60 days.

Additionally, patients who accepted home health care generally reported better quality of life following hospital discharge. Other studies cited in the report had refusal rates as low as 6% among participants.

Care Refusal

Patients are likely to refuse home health care services following a discharge from the hospital for a variety of reasons, but much of the reasoning comes down to a lack of understanding of the benefits, according to Robert Rosati, PhD, vice president of data, research and quality at the Visiting Nurse Association (VNA) Health Group and a member of the Alliance who worked on the final report.

“What surprised me was that this was more common of a problem than I was aware of,” Rosati told Home Health Care News. “Providers encounter patients that refuse [services] but this brought to my attention that this is a bigger issue. There is some deep misunderstanding about what home health care is about.”

Some of the most common reasons for refusing services cited by participants include: already managing care; invasion of privacy; care recipient does not want services; don’t feel that help is needed; services do not meet their needs; do not know about services; cost, including a co-pay in private insurance; previous negative experience; and fear of the unknown.

For some patients, accepting help at home can be overwhelming, and they may not know the value of these services.

“Home health care may be considered by some as an unwelcome reminder of illness, frailty and loss of independence,” the report reads.

For others, inviting a person into their home to perform care services can seem invasive, or they may not want people in their home due to hoarding or illicit behaviors.

Not all refusals for home health care services are seen as “problematic,” according to the report, as family members can often be counted on to help a person at home avoid another hospital visit.

However, more broadly, a smooth transition from hospital to home is important for patient outcomes, and home health care can include complicated services that not all family caregivers can take on.

Patients are not the only ones to “misunderstand” the benefits of home health care services, Rosati said. Family caregivers, who are sometimes the decision-makers for patients, also may lack the knowledge of what home health care can provide. Those that take on family caregiving responsibilities may not fully understand how complex care can be, as well. Providers should boost their education efforts to inform this group in addition to patients, Rosati urges.

“It’s important to think about the informal caregivers and educate them and make them aware about home health,” Rosati said. “Often patients going through this process are not in the best position to make decisions, and other family members are doing it. They are a critical aspect in this.”

Discharge Planning and Care Coordination 

Health care providers may also not fully understand what home heath care services can provide or how patients can benefit, and that disconnect can have an impact on care coordination and the transition to home.

“Part of the problem with physicians is that this may not be a service they make a lot of referrals to because they may not understand it well,” Rosati said. “Providers on the home care side need to do more education with physicians and hospitals on the benefits [of home health care].”

Over the last few years, with hospitals being penalized for readmissions, there has been more focus on discharge planning, and continuity in care from a hospital to home has seen some improvement as a result, according to Rosati.

Continuity in care would likely improve through coordinated discharge planning with home health care services being a part of the standardized policy, the report recommends.


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