Researcher testifies to Congress about rural home health

Less than 60% of Medicare beneficiaries in rural communities who have a planned discharge from a hospital to home health ultimately receive that care, UW Medicine researcher Tracy Mroz reported to a U.S. Senate panel last week.

Even when rural residents are admitted to home health, she said, they face disparities in access to specific services, compared with urban counterparts. Rural residents who are recovering from a stroke or knee replacement, for instance, are less likely to receive rehabilitation services such as physical and occupational therapy at home despite the essential need for this care.

Mroz, an associate professor of rehabilitation medicine at the University of Washington School of Medicine, was called to testify Sept. 19 before the Senate Finance Committee’s Subcommittee on Health Care.  Congress is considering how home healthcare can support aging in place for the 3 million Medicare beneficiaries who use this benefit annually.

She has studied rural healthcare for more than a decade as an investigator with the Washington-Wyoming-Alaska-Montana-Idaho (WWAMI) Rural Health Research Center and the Center for Health Workforce Studies, both funded by the Health Resources & Services Administration.  Her clinical background as an occupational therapist has given her firsthand experience in helping older adults to regain their ability to care for themselves, maintain a household, and participate in work and leisure.

She focused her testimony on home healthcare’s crucial role in supporting aging in place for Medicare beneficiaries, disparities in access to home health in rural communities and drivers of access to care.

“Admission to home health following a hospitalization, known as post-acute home health, helps bridge the transition from the hospital back to home,” Mroz said. “Admission to home health directly from the community, known as community-entry home health, supports beneficiaries with chronic conditions who experience a change in health or functional status that does not require hospitalization but would benefit from services to promote recovery, stabilization, or prevent further decline so the beneficiary can remain safely at home.”

Mroz explained that beneficiaries in the most remote communities are at the highest risk for unmet need due to two key drivers: adequacy of financial resources and health workforce. UW research has unearthed many challenges for rural home health agencies, including travel times and recruiting and retaining staff. The sunsetting of a special add-on payment to home health agencies for serving rural beneficiaries may exacerbate these challenges. Researchers have also found that the presence of a home health agency in a rural community does not guarantee access.

“Rural agencies may refuse referrals for new admissions when they don’t have adequate capacity,” Mroz said, “so it’s perhaps unsurprising that there’s a growing body of evidence on rural-urban disparities in access to home health.”

A recording of the full hearing, including Mroz’s testimony, can be seen here.

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