Saying No to Home Health Services & Wanting to Be Left Alone

Consider those who need home health care but say no. Kaiser Health News recently ran a story on this very topic. Some Seniors Just Want To Be Left Alone, Which Can Lead To Problems explain that the percentage of those who want to be left alone is higher than you may think.  “As many as 28 percent of patients offered home health care when they’re being discharged from a hospital — mostly older adults — say “no” to those services, according to a new report.”  The report is from a roundtable that was sponsored by the Alliance for Home Health Quality & Innovation and United Hospital Fund.  The report, I Can Take Care of Myself: Patients’ Refusals of Home Health Care Services runs 23 pages.

Here are highlights of the report (found on page 1): 

• Medical care is moving from hospitals and other institutions into the community, which for most people means care at home, where they want to be. With shorter hospital stays and more complex post-discharge needs, the importance of home health care services, including skilled care and personal care, in discharge planning and transitional care is increasing.

• Some studies show that patients who receive home health care after hospital discharge are less likely to be readmitted. Other studies show that patients who receive home health care report better quality of life.

• Although data are limited, approximately 6-28 percent of patients eligible for home health care refuse these services, for a variety of reasons.

• Even less 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.

• Recommendations from Roundtable participants include 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.