Why Do Some Patients Refuse Home Health Services, And At What Cost?


Written by Amedisys

A report from a recent roundtable offers some worthy solutions to problems that persist in home healthcare. The focus was on why some patients refuse home healthcare services, the prevalence of such denials, and the consequences, both clinically and economically. Fittingly, the research is titled “I Can Take Care Of Myself!”

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Sponsors of the report and roundtable were the United Hospital Fund, an independent nonprofit organization that analyzes public policy to inform decision-makers; and the Alliance for Home Health Quality and Innovation, a research foundation dedicated to promoting the value of home healthcare to patients and the U.S. healthcare system. Both groups called for steps to be taken when it comes to discharge planning, research and policy.

How Many Patients Are Refusing Home Health—and Why?

The advocacy effort stemmed chiefly from two alarming study findings – that six to 28 percent of patients eligible for home health care refuse those services, and that such patients appear to be twice as likely to be readmitted to a hospital as a result. “Home health care may be considered by some as an unwelcome reminder of illness, frailty and loss of independence,” the report says.

These findings reflect concerns that Amedisys has voiced since its founding 35 years ago. Home health often remains underused and underappreciated, its value underestimated, its services misunderstood. The upshot is that the home healthcare profession needs to do a better job of explaining what it does and why it's important.

“It is paradoxical,” the report says, “that among patients eligible for home health care services post-discharge, a sizeable percentage decline to accept those services. That’s a loss for both patients and caregivers.”

“…among patients eligible for home health care services post-discharge, a sizeable percentage decline to accept those services. That’s a lost for both patients and caregivers.”

Still largely unknown, the report says, is how the whole process works – how hospitals identify patients to refer to home healthcare, for example, and how staff then explain those services to patients and caregivers.

What the Healthcare Industry Can Do About This

The report issued a wide range of ambitious recommendations, starting with how to improve discharge planning. Among actions hospitals should take is to “develop training sessions for physicians, nurses, and discharge planners to ensure that they understand home healthcare and why it may be appropriate for patients.” Also proposed was to create scripts to guide professionals in discussions about home healthcare.

The report also ventured into policy. It urged the home healthcare profession to initiate discussions with CMS about making Medicare eligibility requirements more flexible, particularly waivers required for homebound status, so that services can begin sooner. It also called for establishing incentives, financial and otherwise, to spread awareness among hospitals and healthcare systems about the role home healthcare plays in improving outcomes and lowering readmissions.

Lastly, the report cited a need for further research, particularly qualitative and quantitative studies into the issue of patient refusals. It suggested conducting surveys of discharge planners, hospitalists, social workers and community providers to gauge how they perceive and understand home healthcare services.