Medicare beneficiaries of color used more home health services than white beneficiaries—and were also more likely to rely on unpaid caregivers for their home health care than white beneficiaries, according to a new report from the Commonwealth Fund.

The authors examined a nationally representative survey of Medicare beneficiaries who remained in their homes as opposed to going to institutions to assess the use of different types of home health care providers—that is, home health services and unpaid informal caregivers, who are often family members—by the race and ethnicity of beneficiaries.

Among home health users, the report says, Black (non-Hispanic) and Hispanic Medicare beneficiaries reported, on average, that they received care from home health care providers more than seven months in a year, about half of that time from unpaid informal caregivers. Both Black (non-Hispanic) Medicare beneficiaries and Hispanic beneficiaries were more likely to report using unpaid informal caregivers than agency providers. White Medicare beneficiaries, alternatively, reported receiving in-home provider care for approximately five months per year, and almost equal use of unpaid informal caregivers and agency-sponsored providers.

“Unpaid informal caregiving is often provided by family or friends,” the report says. “Lack of proper training for such caregiving can place a significant responsibility on the individuals receiving care and those caring for them. The greater overall use of such home health care services by Medicare beneficiaries of color suggests that these populations may face more challenges managing their health at home and potentially have worse outcomes, with a greater burden on friends and family.”

The Commonwealth Fund said the Medicare home health benefit is often misunderstood, and providers and home health agencies frequently communicate inaccurate information regarding the benefit to patients. Additionally, this benefit can be narrowly implemented (i.e., providing fewer hours of home health aide services than the benefit allows by law), potentially limiting the assistance granted by health insurance coverage. The financial strain of securing home health services and supports may be greater for Medicare beneficiaries of color: the median per capita savings among white Medicare beneficiaries is more than six times the savings accumulated among by Black or Hispanic beneficiaries.

“Ensuring that Medicare beneficiaries have equitable access to high-quality home health care providers merits greater attention,” the report concludes. “The Medicare home health benefit is not adequately addressing the needs of its beneficiaries in sufficiently lowering access barriers to the highest quality of in-home services and supports. It will be important to further explore the different types of in-home providers used across racial and ethnic groups in the Medicare population and the quality of care they can provide, as well as the reasons why certain groups have worse health outcomes than others.”

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