Social Work During Skilled Home Healthcare: Prevalence and Determinants

Medicare-funded home health (HH) delivers skilled care via visits to patients' homes. Social work (SW) services are included within the HH benefit and may positively affect outcomes for HH patients with complex needs. However, no prior work has quantitatively assessed SW provision during HH.

We examined 2018 linked HH claims, assessment, and HH agency data for a national sample of 1 372 570 Medicare HH patients. We described the prevalence, number, and timing of SW visits, compared characteristics of those who did versus did not receive SW, and modeled odds of receiving SW using a multilevel logistic model clustering at the HH agency level and adjusting for patient sociodemographic characteristics and clinical status and HH agency characteristics.

Just 11.3% of HH patients received SW. On average, those who received SW had a single SW visit (mean = 1.3; standard deviation [SD] = 0.6) occurring about a week (mean = 8.8 days; SD = 6.6) after HH admission. The patient-level factors most significantly associated with receiving SW included being non-Hispanic Black compared to non-Hispanic White (adjusted odds ratio [aOR]: 1.70; 95% confidence interval [CI]: 1.66-1.74), being Medicaid-enrolled (aOR: 1.26; 95% CI: 1.24-1.28), living alone (aOR: 1.31; 95% CI: 1.28-1.33), having high cognitive impairment (aOR: 2.12; 95% CI: 2.07-2.18), and exhibiting depressive symptoms (aOR: 2.17; 95% CI: 2.10-2.23). Patients also had greater odds of a SW visit if receiving care from an HH agency that was nonprofit (aOR: 1.31; 1.19-1.45) and lower odds if the HH agency had a rural service area (aOR: 0.67; 95% CI: 0.61-0.74).

Findings indicate that SW access remains rare during HH and is driven by both demand-side (ie, patient needs) and supply-side (ie, agency characteristics) factors. There is a need to identify patient profiles most likely to benefit from SW services during HH and to develop strategies to mitigate agency-level barriers to access.