Unequal By Condition: Medicare's Planned Neglect of Chronic Care in Home Health

The presentation is based on a study conducted from July 2016-August 2017 in two Medicare-certified home health agencies in the metropolitan Philadelphia area.The study is the first to compare care for Medicare home health patients with chronic conditions (Alzheimer's disease,Multiple Sclerosis, Parkinson's disease, Cancer, Diabetes, and chronic respiratory and circulatory conditions) to patients with acute care conditions (wound care; physical, speech, or occupational therapy-based rehabilitation post-surgery; non-chronic diabetes; acute musculoskeletal conditions). A mixed method methodology was used. A sample of 23 chronic care and 26 acute care patients were randomly-selected as the sample. Patient care was compared based on: assessed needs; length of stay; type and volume of services delivered; and outcomes using agency data. All subjects were interviewed on their perceptions of actual care delivered matched their needs; remaining unmet needs; and consequences for their life activities. Results found a consistent bias toward acute care patients based on all criteria examined and patient interviews of unmet needs.