How a Community Increases Trust in Homecare

Home health care is dramatically underutilized in the Black community, resulting in poorer health outcomes than their majority counterparts. In the Rochester and Finger Lakes regions of New York, the outcome disparities are alarming.

Compared to white people, Black people in the region face dramatically higher rates of premature mortality from nearly every condition, including heart disease (133% higher), diabetes (146% higher), cancer (35% higher) and premature birth disorders (218% higher), according to “The Color of Health: The Devastating Toll of Racism on Black Lives,” a report by Common Ground Health, a nonprofit health research and planning organization.

Rochester County “has some of the more dire health outcomes and health disparities in the nation,” said a separate report produced by the Racial and Structural Equity (RASE) Commission, which was appointed by the city of Rochester. “Life expectancy ranges from 72.4 years in some city zip codes to 81.1 years in some of the suburbs.”

These health disparities were highlighted during the COVID-19 pandemic, when older Black adults experienced a high incidence of the disease, more hospitalizations and more deaths.

HCR Home Care, a New York-based home health care provider, is looking to reduce health disparities that disproportionately affect people of color. As part of the effort, HCR is implementing a project that looks to improve access and remove barriers to home health care services for residents over 65. To spread the word about this effort, HCR is partnering with pastors from predominantly African-American churches to inform older adults and their families about the availability, affordability and benefits of home health care.

The project is building on an earlier pilot program from its nonprofit partner, HCR Cares, which focuses on addressing barriers to independent living through research.

HCR Cares initially identified more than 130 predominantly Black churches in the Rochester area to help older adults in their congregations overcome barriers to using home health care services in order to improve their health outcomes. Pilot project funding was provided by the Greater Rochester Health Foundation and the Max and Marian Farash Charitable Foundation.

The Diverse Care Project was formed to assess the need for increased awareness of homecare programs and services among Black religious leaders. The strategy behind it was based on the belief that clinical services complement faith-based approaches, but encouragement by Black religious leaders could help overcome barriers to homecare utilization.

The project aimed to address the following barriers: lack of knowledge about home health care benefits and what is covered by insurance; lack of trust in the health care system; concerns about providers coming into the home; preference and/or expectations of family support; religious beliefs that may delay early medical intervention; and the absence of an assigned primary care physician.

Additionally, the project looked to demonstrate the capacity of the private, non-governmental health care system to meet the recommendations of the RASE Commission’s identification of disparities and inequities as a major issue.
The project identified two significant challenges:

1. It was difficult to establish direct communication with pastors. Some churches have office personnel to assist with meeting scheduling, while others do not. This greatly affected the timeline associated with getting the information to the clergy and delayed the distribution of information to the congregations.
2. Pastors requested customized print and digital materials, which required more time and resources to develop than originally planned.

Despite these challenges, the pilot project achieved encouraging preliminary results. HCR created a comprehensive database of 137 Black churches and cultivated close relationships with the pastors and influential members of the churches. Approximately 30 of the 137 churches are actively engaged in the program.

HCR received 55 referrals for homecare for people who would not have received it otherwise. These patients experienced ailments such as COVID-19, depression, diabetes, heart disease, heart failure, joint replacement, kidney disease and obesity. Types of care provided included skilled nursing, social work, physical, occupational and speech therapy, and home health aide services.

An additional 181 Black elders received care from HCR Home Care as well, but it is not clear whether these patients came from a referral through the project.

HCR looked to reduce mistrust through pastor endorsements and patient testimonials, which demonstrated to Black parishioners that homecare services could be trusted. Pastor endorsements used in education materials included:

“Our seniors have told us they wish there was an organization that could help them,” said Sebrone O. Johnson, senior pastor of Greater Harvest Church. “I am so very grateful for HCR and the homecare they provide. They are truly making a change in the lives of our seniors. We will continue to partner with HCR to provide for the most vulnerable portions of our congregation.”

“If you need care, you don’t always have to go to a hospital,” said Julius C. Clay, pastor of New Bethel CME Church. “You can receive care in the comfort of your own home. You should consider giving HCR a call for all of your homecare needs. I highly recommend them!”

The Diverse Care Project is an innovative approach to addressing the longstanding chronic issue of overcoming health care delivery disparities among Black older adults. With additional funding through an American Rescue Plan Act grant secured by Congressmember Joseph Morelle, Monroe County Executive Adam Bello and the Monroe County Legislature, HCR said it hopes to achieve more meaningful results, as it strives to improve access to care, promote health equity and reduce health disparities.

HCR Home Care said the additional funding will enable it to provide Community outreach to empower faith leaders to educate their congregations about home health care resources. Culturally relevant education materials and messaging tailored to each church community; video testimonials highlighting families’ experiences with home health care. Workforce training materials for pastors and church leaders to help strengthen the pipeline of culturally competent home health care workers.

As HCR continues to expand the project—learning from the challenges it has faced during the demonstration project and building on the initial outcomes it has achieved—HCR hopes to reach more older adults in the Black community and provide the information they need to not only get access to, but also to trust home health care.