Out Of Reach: Inequities In The Use Of High-Quality Home Health Agencies

Shekinah A. Fashaw-Walters, Momotazur Rahman, Gilbert Gee, Vincent Mor, Michael White, Kali S. Thomas

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Patients receiving home health services from high-quality home health agencies often experience fewer adverse outcomes (for example, hospitalizations) than patients receiving services from low-quality agencies. Using administrative data from 2016 and regression analysis, we examined individual-and neighborhood-level racial, ethnic, and socioeconomic factors associated with the use of high-quality home health agencies. We found that Black and Hispanic home health patients had a 2.2-percentage-point and a 2.5-percentage-point lower adjusted probability of high-quality agency use, respectively, compared with their White counterparts within the same neighborhoods. Low-income patients had a 1.2-percentage-point lower adjusted probability of high-quality agency use compared with their higher-income counterparts, whereas home health patients residing in neighborhoods with higher proportions of marginalized residents had a lower adjusted probability of high-quality agency use. Some 40–77 percent of the disparities in high-quality agency use were attributable to neighborhood-level factors. Ameliorating these inequities will require policies that dismantle structural and institutional barriers related to residential segregation.

Original languageEnglish (US)
Pages (from-to)247-255
Number of pages9
JournalHealth Affairs
Issue number2
StatePublished - Feb 2022

Bibliographical note

Funding Information:
This study was previously presented at the AcademyHealth Annual Research Meeting (virtual), July 2020. The presentation was titled “Assessing Racial-, Ethnic-, or Socioeconomic- Disparities in Access to High-Quality Home Health Agencies.” This work was supported in part by National Institute on Aging Grant No. R36-AG068199. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the National Institutes of Health, the Department of Veterans Affairs, or the United States government. Vincent Mor is a paid consultant to NaviHealth, Inc., and chairs its Scientific Advisory Board. NaviHealth is an independent entity within OPTUM. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See https:// creativecommons.org/licenses/by/4.0/.

Publisher Copyright:
© 2022, Project HOPE. All rights reserved.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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