Racial/Ethnic Disparities in Home Health Care for Persons with Alzheimer’s Disease and Related Dementias
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Abstract Alzheimer’s disease and related dementias (ADRD) affect 5.8 million Americans and disproportionately impact racial/ethnic minorities. Despite their complex health and social needs, the majority of persons with ADRD live at home and prefer to do so for as long as possible. Consequently, there is a rapid growth in the demand for home health care (HHC), a leading form of home- and community-based services (HCBS) to support this vulnerable population. The need for HHC is further intensified among racial/ethnic minorities as research has shown that they had higher prevalence of ADRD and more severe symptoms of dementia but limited financial resources for institutional care. At the same time, research from care settings other than HHC has indicated that minorities such as Blacks and Hispanics are less likely to receiving care from high-quality facilities and are more likely to have worse outcomes (e.g., rehospitalization and poor function). However, it is unclear whether similar differences exist among persons with ADRD in the HHC setting. It is also unknown is whether such racial/ethnic differences are affected by health policies (i.e., home health value-based purchase model, HHVBP) aiming at improving quality and efficiency of HHC and the availability of HHC resources, nor how much of the differences can be explained by individual characteristics. We therefore propose a project to elucidate racial/ethnic disparities in quality of HHC among persons with ADRD. This study has two specific Aims: Aim 1) To examine admission to high-quality home health agencies among racial/ethnic minority HHC recipients with ADRD (i.e., non-Hispanic Blacks, Hispanics, Asians, and Native Americans), compared to their White counterparts. We hypothesize (1) racial/ethnic minorities with ADRD are less likely to be admitted to high-quality agencies than their White counterparts, and (2) such differences are smaller in areas with HHVBP model and larger in areas with less HHC resources; and Aim 2) To determine quality outcomes of racial/ethnic minorities with ADRD during HHC, comparing to their White counterparts. We hypothesize that racial/ethnic minorities with ADRD experience poorer outcomes, including higher risk of rehospitalization and less improvement in function during HHC, than their White counterparts. We will also explore how much of these racial/ethnic differences can be explained by individual and environmental factors. This study is innovative because it is the first to creatively link multiple national datasets and use Blinder-Oaxaca method to elucidate racial/ethnic disparities in the quality of HHC among persons with ADRD. This research is significant as it addresses a growing public health concern regarding the quality and equity of care for this vulnerable population. Findings from this study will enrich our knowledge regarding home- and community-based services to racial/ethnic minorities with ADRD. The findings will inform future efforts aiming at reducing health disparities and improving quality and outcomes of dementia care in the HHC setting. It has immediate implications for health policy and practice.
