Black patients are less likely to get a referral for home health care after a hospital stay, according to a new paper authored by Dr. Marianne Weiss, professor of nursing at the University of Marquette, Dr. Olga Yakusheva professor of nursing at the University of Michigan, Dr. Abiola Keller professor of nursing at the University of Marquette, and Kathryn Lee from the University of Michigan School of Nursing in the journal Medical Care, an American Public Health Association publication.
The research found that, despite statistically higher risk factors for hospital readmission, Black patients were referred to home health care at a rate of 22 percent; which is well below that of white patients at 27 percent.
“My first career was as a physician’s assistant and that’s kind of how I got interested in the topic of health inequities and disparities,” Keller tells Madison365. “It was actually what I saw in my clinic practices in terms of differences in what people were coming to the clinic for and the severity of things.” She explains that she was looped into this research project as one of the experts surrounding the impact of ethnic, racial, and gender identities on public health access.
“The hospital is there to provide acute care or high-level care,” Dr. Keller continues. “When people are really sick they are in the hospital, but the hope is that we can get them to a place where they can return to their home or community to continue to get better or back to baseline.” Black and Hispanic patients, in this study, were found to have higher odds of rehospitalization during their home healthcare episode and within 30 days post-discharge. Dr. Keller’s work on this project opens a lens into new possibilities for bridging health disparity gaps among these ethnic groups.
A wide range of service providers may be a necessary tool when considering options of care, outside of the hospital. Dr. Keller describes the home healthcare referral process as a “team decision” because there are many options for individualized care.
”Ultimately if you looked, everything else was the same, except for the race of the patient. What we were seeing was that in order to have that home health care in place, Black patients had to be sicker in comparison to white patients,” Dr. Keller said. The research also suggests that Black patients were found to be less likely to be married, more likely to live alone, and have more chronic conditions than white patients, which highlights a disparity in alternatives for after-treatment care.
Dr. Keller infers that possible solutions include healthcare systems and providers that seek to “speak the same language” of their patients and the communities around them. She tells Madison365, “There is some work that needs to be done in understanding what patients’ experiences are in thinking about their health care.”
For Dr. Bashir Easter, founder of Melanin Minded LLC, these findings are reinforced in his personal and professional experiences with a mission that seeks to mitigate the risks associated with racial inequities during home health care referrals, as well as providing many avenues to preventative and individualized care.
Dr. Easter’s Melanin Minded is an “organization established with the mission to be the bridge for information, service, and support for people of color with long-term vision to empower and equip people of color to have optimal quality of life.” His work is rooted in the foundations of personal experiences, having been a caregiver for his mother after she was diagnosed with dementia at age 55.
“The reason why I chose the bridge, is because the bridge is constructed to be able to get people on either side, and it protects them from everything that is under the bridge,” Dr. Easter tells Madison365. From youth, to adults, and the surrounding community that can encompass a wide range of alternatives to home health care, Dr. Easter’s work highlights how multicultural family and community dynamics may influence the health care systems and home health care treatments.
Dr. Easter’s current programs include Navigator Coaching, which strengthens the caregiving team of an individual or family seeking to navigate the Alzheimer’s disease process. This serves as a five-point system that seeks to address the many barriers associated with the findings mentioned by Dr. Keller and the co-authors.
Dr. Easter also seeks to address barriers to access by establishing a navigation and transportation aid, called My Melanin Ave, that gets patients with dementia connected with their resources and community, when driving is no longer an option. By widening the possibility of care through direct services, Melanin Minded is a great example of a community organization that is seeking to change the environments that produced the disparities presented by Dr. Keller and her team.
Other barriers to access or “deterrents,” as Dr. Easter explains to Madison365, there can be factors such as medical bills, preventative care such as having a family physician, or exploring insurance options for under-insured communities. Dr. Easter shares his insight by saying, “Now that we have more of the internet and more information, people are recognizing that you should have someone that you can trust.”
Programs like Melanin Minded and research presented by doctors and physicians like Dr. Keller and her team are facilitating a new process of trust that seeks to empower the communities most affected to make the most informed decisions they can when it comes to their health.
