Characteristics Associated With Home Health Care Referral After Discharge From Hospital.

Area of Science:

• Gerontology
• Health Services Research
• Public Health

Background:

• Older adults increasingly prefer home recovery, making home health care (HHC) a vital alternative to institutional post-acute care.
• Understanding factors influencing HHC referrals is crucial for aligning care with patient preferences and supporting aging in place.

Purpose of the Study:

• To examine individual, hospital, and community characteristics associated with HHC referral versus institutional post-acute care among Medicare beneficiaries.
• To identify determinants of post-acute care choices at hospital discharge.

Main Methods:

• Retrospective observational study using 100% Medicare fee-for-service claims (2017-2019).
• Included beneficiaries referred to HHC, skilled nursing, or inpatient rehabilitation.
• Utilized mixed-effects linear probability models to assess associations between individual, hospital, and community factors and HHC referral.

Main Results:

• Over 11 million hospital discharges were analyzed.
• Factors associated with lower HHC referral included older age, longer hospital stays, urban residence, and dual eligibility.
• Beneficiaries of color and those in communities with higher minority and older adult populations had higher HHC referral rates. Large, non-teaching, and safety-net hospitals also showed higher referral rates.
• Models explained only 13% of referral variation, highlighting limitations of administrative data.

Conclusions:

• Post-acute care referral decisions are complex, influenced by a combination of individual, hospital, and community factors.
• As HHC use grows, attention to referral decision-making is essential for equitable access to preferred and appropriate care for older adults.