There is significant literature on the importance of addressing social determinants of health (SDOH) in order to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded the ability of Medicare Advantage plans to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. The current study is an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 37 home care nurses between January 2013 and May 2014 in the New York City metropolitan area. Results indicate that nurses believe the lack of SDOH coverage in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and re-hospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs.
MachledtD.Addressing the social determinants of health through Medicaid managed care. Issue Brief (Commonw Fund). 2017; 2017:1-9.
2.
DavisKWillinkAStockwellIWhitonKBurgdorfJWoodcockC.Designing a Medicare help at home benefit: lessons from Maryland’s community first choice program. Issue Brief (Commonw Fund). 2018.
Deloitte Center for Health Solutions. Social Determinants of Health: How Are Hospitals and Health Systems Investing in and Addressing Social Needs?New York, NY: Deloitte; 2017.
6.
ParadiseJRossDC.Linking Medicaid and Supportive Housing: Opportunities and the On-the-Ground Examples. Washington, DC: Kaiser Family Foundation; 2017.
7.
ArtegaSHintonE.Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. San Francisco, CA: Kaiser Family Foundation; 2018.
8.
SpencerAFredaBMcGinnisTGottliebL.Measuring Social Determinants of Health among Medicare Beneficiaries: Early State Lessons. Hamilton, NJ: Center for Health Care Strategies; 2016.
9.
Commission on the Social Determinants of Health. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Geneva, Switzerland: World Health Organization; 2008.
MarmotD.Fair Society, Healthy Lives: The Marmot Review- Strategic Review of Health Inequalities in England Post-2010. London, England: UCL Institute of Health Equity; 2010.
12.
MarmotD.Health Inequities in the EU. London, England: UCL Institute of Health Equity; 2013.
13.
MarmotD.The Health Gap. Bloomsbury, England: Bloomsbury Press; 2015.
14.
MarmotD.The health gap: doctors and the social determinants of health. Scand J Public Health. 2017;45:686-693.
DanielHBornsteinSSKaneGC.Addressing social determinants to improve patient care and promote health equity: an American College of Physicians position paper. Ann Intern Med. 2018;168(8):577-578.
17.
Medicare Payment Advisory Commission. Medicare Basics: Home Health Services. Washington, DC: Medicare Payment Advisory Commission; 2018.
National Alliance for Caregiving. Caregiving in the U. S. Bethesda, MD: National Alliance for Caregiving; 2015.
27.
ChangH-J.The correlation of home care with family caregiver burden and depressive mood: an examination of moderating functions. Int J Gerontol. 2009;3(3):170-180.
28.
HokenstadAHartAGouldDHalperDLevineC.Closing the home care case: home health aides’ perspectives on family caregiving. Home Health Care Manag Pract. 2006;18:306-314.
29.
KelloggFRBricknerPW.Long-term home health care for the impoverished frail homebound aged: a twenty-seven-year experience. J Am Geriatr Soc. 2000;48(8):1002-1011.
30.
RansmayrGHermannPSallingerK, et al. Caregiving and caregiver burden in dementia home care: results from the Prospective Dementia Registry (PRODEM) of the Austrian Alzheimer Society. J Alzheimers Dis. 2018;63(1):103-114.
