After a hospitalization, home healthcare enables patients to recover where they feel most comfortable: in their homes. Nurses visit patients to provide care to keep them at home, given that hospital readmissions cost the U.S. healthcare system more than $41 billion each year.
A new study finds that for people with limited ability to communicate in English, having the same home health nurse across visits significantly decreases hospital readmissions, regardless of whether the patient and nurse speak the same language. The findings, published in the journal Medical Care, can inform how home health agencies staff the care of patients with limited English proficiency by having the same provider throughout a patient’s care.
“While having both the continuity of the same nurse across multiple visits and a nurse who speaks the same language as the patient is ideal, enhancing continuity of care for those where there is language discordance between themselves and the healthcare provider may be helpful to address disparities and reduce hospital readmission rates,” says Allison Squires, PhD, RN, FAAN, associate professor at NYU Rory Meyers College of Nursing and the study’s lead author.
Improving Outcomes in Home Care
Research shows that home care patients who speak a language other than English are at a higher risk for readmission to the hospital. Language gaps between patients and healthcare providers contribute to disparities in health outcomes and may be particularly challenging in home healthcare. Home care agencies frequently rely on telephone interpretation services since many of their clients need the level of internet access required for video interpretation. Interpreter services are often only reimbursed by insurance if state law requires it.
“Home care agencies should aim to hire and retain nurses that speak the same languages as their patients, but realistically, there are not enough nurses to meet this demand,” says Squires.
A growing body of research shows that having the same provider—known as continuity of care—across multiple home care visits can improve health outcomes and may be a more viable staffing solution to prevent hospital readmissions.
Same Nurse or the Same Language?
To understand the impact of having a consistent provider or someone who speaks the same language on hospital readmissions, the researchers examined data from 22,103 patients receiving home care in New York City following a hospitalization. The patients spoke Spanish, Korean, Chinese, or Russian as their primary language.
The researchers found that having the same nurse across home care visits who spoke the same language as the patient had the best chance of reducing the risk of hospital readmissions. However, having the same nurse across home care visits, even if they didn’t speak the same language as the patient, was also linked to lower hospital readmissions. Having different nurses increased the risk of readmission with this population, but the risk varied by language.
“It is thought that the more often a nurse interacts with a patient, the more likely they are to get to know them and their family or caregivers, regardless of whether there is a language barrier,” says Squires.
What This Means for Home Healthcare Agencies
The researchers conclude that healthcare providers should maximize continuity of care after hospitalization—particularly when language barriers cannot be addressed directly through staffing.
“For providers referring patients to home healthcare services and coordinating these referrals, it may be worth considering an agency’s ability to support continuity of skilled nursing care to reduce the odds of hospital readmission,” says Squires. “Home healthcare organizations should assign providers with an eye towards ensuring that a patient’s preferred nurse can remain involved in their treatment throughout their care.”
Squires notes that being able to assign the same home health nurse across visits has its challenges, given the home care industry’s difficulty attracting and retaining providers and their heavy reliance on per-diem workers.
“Achieving continuity of care is only possible if a home care organization can recruit and retain nurses,” says Squires.