The decentralized nature of home health services leaves providers and payers vulnerable to extreme weather, and new research shows that hurricane floods can tack nearly two weeks onto treatment times.
Hurricanes and related flooding were associated with delays to home health services, longer treatments and lower rates of successful return to patients’ communities, according to a research letter published in JAMA Health Forum.
“Extreme weather events may inflict widespread disruption in an already decentralized system and network of [home health care],” the study’s authors wrote. “For example, extreme weather events may prevent [home health care] agency nurses and other professionals from traveling to patients’ homes, interrupt communication systems and halt delivery of supplies.”
The study focused on Hurricane Sandy, a superstorm that hit the Caribbean and the northeastern United States on Oct. 29, 2012. The National Oceanic and Atmospheric Administration reported that Sandy killed at least 117 people in the U.S. and that its damage surpassed $68 billion, making it the second costliest storm behind Hurricane Katrina.
The researchers first examined Medicare Part A/B beneficiaries receiving home health services when Sandy made landfall in October 2012, comparing exposure to hurricane-related flooding and health outcomes between beneficiaries in New York City, Connecticut and New Jersey.
The researchers divided the beneficiary group under study into those who resided in ZIP codes affected by Sandy’s flooding and those in nearby ZIP codes that were not flooded.
The sample comprised 761 Medicare beneficiaries, with an average age of 77.3 years. Of them, 432 were exposed to flooding and 329 were not. Individuals living in flooded areas were similar to those in non-flooded areas in terms of age, sex and medical conditions like Alzheimer’s disease and congestive heart failure. The groups differed by some race and ethnicity categories and by state of residence.
The researchers compared timely start of care, improved medication management, mean home health length of stay, discharge to a skilled nursing facility and discharge to the community between the two groups.
They found that those who lived in non-flooded areas were more likely to not only receive a timely start of care, but also to be discharged to their communities. Additionally, home healthcare in a flooded area was associated with an average of 12.9 additional treatment days. However, the study noted no statistically significant change in home health medication management or the number of people discharged to skilled nursing facilities.
“These findings underscore the vulnerability of [home healthcare] recipients to flooding and invite further questions about the incorporation of [home healthcare] into broader health care emergency planning efforts at local and regional levels,” the researchers wrote.
The researchers noted that the findings were not necessarily generalizable to the Medicare Advantage population, had limited power to reveal differences in other health outcomes and could not control for home health agency characteristics because these data were not available in 2012.
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