Social Work During Skilled Home Healthcare: Prevalence and Determinants

Area of Science:

• Gerontology
• Health Services Research
• Social Work

Background:

• Home health (HH) provides essential skilled care to patients in their homes.
• Social work (SW) is an integral part of the HH benefit, potentially improving outcomes for complex patients.
• Quantitative data on SW service provision within HH is lacking.

Purpose of the Study:

• To quantitatively assess the prevalence, characteristics, and predictors of social work (SW) service utilization among Medicare home health (HH) patients.
• To identify patient-level and agency-level factors associated with receiving SW services during HH.

Main Methods:

• Analysis of a national sample of 1,372,570 Medicare HH patients using linked claims, assessment, and agency data from 2018.
• Descriptive statistics for SW visit prevalence, number, and timing.
• Multilevel logistic regression modeling to identify factors associated with SW receipt, accounting for patient and agency characteristics.

Main Results:

• Only 11.3% of Medicare HH patients received SW services, typically a single visit shortly after admission.
• Patient factors significantly associated with higher SW odds included non-Hispanic Black race, Medicaid enrollment, living alone, high cognitive impairment, and depressive symptoms.
• Agency factors associated with higher SW odds included nonprofit status; rural service areas were associated with lower odds.

Conclusions:

• Access to SW services in home health (HH) remains limited and is influenced by patient needs and agency characteristics.
• Strategies are needed to improve SW access for HH patients, particularly for those with complex needs.
• Further research should identify patient profiles that benefit most from SW and address barriers to care.