Healthcare Industry News: When Patients Refuse Home Healthcare

September 5, 2017 Jeanette Stern

Healthcare Industry News: When Patients Refuse Home Healthcare

In May of 2017, the United Hospital Fund and the Alliance for Home Health Quality and Innovation reported that 6-28% of patients, mostly younger, healthier seniors, refused home healthcare services even though Medicare would cover the cost.


According to a study by the Pennsylvania School of Nursing in 2015, "Refusers were significantly younger (average age 68 years vs 73 years; P < .001), as well as more likely to be married (62% vs 46%; P < .001), privately insured (35% vs 18%; P < .001), and with lower risk of mortality/severity of illness. Refusers also had shorter hospital stays (4.8 days vs 7.5 days; P < .001); higher quality of life after discharge (0.83 vs 0.73; P < .001); and fewer unmet needs after discharge. However, refusers had higher 30-day (21% vs 16%; P = .17) and 60-day (31% vs 25%; P = .18) readmission rates; with logistic regression showing about twice-higher odds of 30-day (OR [odds ratio], 2.13; 95% CI, 1.11-3.02; P = .01) and 60-day (OR, 1.8; 95% CI, 1.11-3.02; P = .02) readmission."


The Report

Titled, I Can Take Care of Myself, the report was the result of a roundtable discussion attended by healthcare leaders across the country. The conference explored the effects of post-discharge home care on patient outcomes, the reasons patients refused care and ways to improve engagement between patients, hospitals, and home healthcare providers with Medicare certified agencies offering the skilled care rendered by nurses and therapists and prescribed by a physician as medically necessary. Its conclusions are as follows:

  • The trend toward shorter hospital stays means more patients will require skilled care in their homes after they are discharged.

  • Several small studies indicated that home care after discharge can reduce the rate of readmission and improve the patient's quality of life.

  • Surprisingly little data exists about why patients refuse home care and how hospitals refer and explain home care services to them and their family members.

  • Patients may have different attitudes toward receiving home care than their family members and healthcare providers for a variety of reasons.

  • In order to ensure patients get the care they need, caregivers and healthcare professionals must address the reasons home care gets refused.

  • Industry policies, patient eligibility requirements, costs, and the shortage of skilled care workers all reduce the availability of home care services.


Why do patients refuse home care?

  • Fear of allowing strangers into the home.

    • Recovering from an illness or surgery can be a frightening experience, especially for seniors facing a loss of independence. All too frequent stories in the media of elder abuse and victimization also cause concern. Dementia and Alzheimer's patients may not be able to understand why a caregiver is in their home and become fearful. Others feel resentful and don't want what they view as a babysitter hovering over them, or may have had a negative experience with home care in the past.


  • Failure to understand the services offered.

    • Robert Rosetti, vice president of research and quality at the Visiting Nurse Association Health Group in New Jersey, told Kaiser Health News in June that a breakdown in communication between patients and healthcare professionals is often at fault.

    • "Patients haven't been told, in clear and concrete terms, which services would be provided, by whom, for how long, how much it would cost and what the expected benefit would be. So, they don't understand what they're getting into, prompting resistance," said Rosetti.


  • Concern about the cost.

    • Patients and their family members may not know that Medicare covers skilled in-home aftercare from nurses, therapists, and medical professionals for homebound seniors and those needing intermittent or short-term care.  



  • Improved discharge planning is the key to increasing engagement between patients and caregivers. Patients need to be included in the decision-making process regarding aftercare.

  • Properly training doctors, nurses, and hospital staff on when and how to recommend home care is necessary. Healthcare professionals and patients may benefit from scripts and videos to facilitate discussions that will better inform patients of the services available, why they are needed, who will be carrying them out, and how they will be paid for.

  • Emergency departments, skilled nursing facilities, and home health service providers should work together to include home health referrals in discharge planning when appropriate.

Patients wanting to return home and to their normal activities as soon as possible often underestimate the type and duration of aftercare required to ensure the best outcome. Family members, especially elderly spouses, are often unequipped to deal with the complex medical and mobility needs of their loved ones after hospitalization or trips to emergency departments, leading to unintended health consequences and costly hospital readmissions. Better communication between providers, health plan members, and family caregivers can ensure better outcomes for recently discharged patients.


MedXM is dedicated to improving the quality of care with the goal of providing better outcomes for health plan clients. Contact us with questions about your next health assessment today.

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