Article Analysis on Home Health Agency Work Environments and Hospitalizations

Article Analysis on Home Health Agency Work Environments and Hospitalizations

Description of the study

The authors Olga Jarrín, Linda Flynn, Eileen Lake and Linda Aiken in their article Home Health Agency Work Environments and Hospitalizations seek to ascertain the relationship between home healthcare and rates of hospitalization and discharges with respect to community living. The aspect of the goal of home healthcare being to help patients to stay in community living arrangements is addressed in the article. However, this is usually not the case since home care fails to prevent hospitalizations and hence prevents facilitation of discharges to community living. This issue is important to the nursing profession as it helps to take medical care of patients in their homes rather than burdening healthcare in hospitals. The home care setting encompasses a situation whereby there is more interaction between patients and nurses and less nurse-physician relation hence the system is dependent on the independent input of involved nurses.

Evaluation of Literature

Home healthcare is a healthcare system which specializes in offering various medical services to patients in their homes rather than the patients having to go the healthcare centers. It employs the services of professionals such as occupational therapists, nurses, physical therapists and speech and language therapists. Additionally, the system encompasses the services of social workers who are instructed by healthcare professionals on which patients are in need of care. This system is unique and is different from other healthcare service settings as healthcare delivery is provided  in the patients’ homes. However, this is done with administrative support being provided from a central office. Studies show that home care is one of the healthcare sectors with the highest growth rates. Presently, it encompasses more than 12,000 home health agencies which serve about 4.5 million Medicaid and Medicare patients every year (Jarrín, Flynn, Lake & Aiken, 2014). The main objectives of home care is to assist patients in restoring their health and to help them to remain in the community and thereby avoiding admission to long term care institutions or unnecessary hospitalizations.

Contemporary and comprehensive literature reviews show that home healthcare plays a big part in consistently and efficiently reducing mortality and minimizing to a great extend long-term institutional care while restoring patient’s functional ability. There has been comprehensive research on the effectiveness of home care on individuals. Home care services result in less hospital admissions. It is also shown that self-management by patients encouraged effective and efficient end of life patient-centered care planning, which is common in home care.

From various literature reviews, it is shown that the responsibility of reimbursing the formal home healthcare services in United States is covered by Medicaid or Medicare. The reimbursement is done in sixty-day blocks of time. The reimbursement takes the medical expenses incurred into consideration when taking care of a patient and the need for any professional consultations which are to be paid for. However, Centers for Medicaid and Medicare Services (CMS) have been cutting down on the home healthcare payments.

In 2011, sequestration further cut the home health payments by 2%, a trend that went on for the next 10 years leading to a reduction in payments of about $6 billion (Jarrín et al, 2014). In essence, this negative trend has led to the federal government cutting the amounts to be spent on home care services. This is a system which is rarely in the limelight thus it does not elicit much attention from the public. However, this system is as crucial as the mainstream healthcare industry. The impact of such reductions have dire consequences on the functioning of the home care system.

Contemporary research shows that most of home health operating expenses go to nursing and therapy staff salaries. Reduction in Medicare payments leads to poor payments to such healthcare professionals and leads to poor quality in the operations of home health agencies since there is pressure to ration care. Research also shows that home health nurses work significantly more hours than nurses in other settings. Additionally, productivity requirements implemented by home health agencies add to nurses’ workload. When this issue is combined with other cost-saving measures it usually increases turnover of experienced nurses and leads to a decrease in the quality of services (Medicare Payment Advisory Commission, 2012). As such, the given environment in which home care nurses work affects the quality of service that the nurse is able to offer.

Study Sample

The study sample was obtained from nurse survey data obtained as part of the University of Pennsylvania multistate patient safety and nursing care study in the year 2006. A questionnaire was sent to respondents in three states to randomly selected RNs. The sample comprised 40%–50% of all RNs in the selected states which were Pennsylvania, New Jersey, and California. The nurses had to have more than 20 years’ experience in their respective work professions. It was also noted that the response rate was thirty nine percent hence the sample was comprised of 79,158 RNs. From this sample, 4.7% of the RNs which translated to 3739 nurses worked in home healthcare. A survey of non-respondents used more extensive contact methods and achieved a 92% response rate that had no response bias of any significance. After indicating the names of their employing agencies they were reconciled with the names of the nurses via internet searches and phone calls. As such, the study encompassed an analysis of nurses’ responses and checked the agencies that employed them to ensure a comprehensive research approach.

Study Methods and Design

The research method was a cross-sectional study. Both quantitative and qualitative data were collected.  Available state survey data on nurses and federal database information on healthcare and home health agencies were instrumental in the design of the study.  The Practice Environment Scale of the Nursing Work Index (PES-NWI) was encapsulated into the survey to ascertain the characteristics of the work environment (Jarrín et al, 2014). In this study, the nurses acted as informants about their home healthcare employing agencies. Cross sectional analysis of the chosen research demographics was used to attain the objectives of the study. Quantitative data analysis was used in analyzing numerical data whereas qualitative data analysis was used to analyze the different views held by the respondents to capture their underlying perceptions.


Most of the Medicare-certified home healthcare agencies (76%) studied were nonprofit organizations. It was first confirmed that the organizations offered all the crucial medical services that were offered by the nurses offered to individuals at their premises such as different types of therapies, medical services as well as specific home health help. The sample used in the study entailed research on various agencies which employed nurses. The results showed that 39% of the sampled nurses had a tertiary level of education while 27% possessed a specialty certification.

Overall, 83% of the respondents were satisfied with their jobs with 12% of the respondents intending to leave their positions in the subsequent year (Jarrín et al, 2014). The results also showed that 29% of the nurses complained of high levels of burnouts while 21% of the nurses stated that their heavy workload made them miss crucial changes in their patients’ health condition. Lastly, a significant 23% stated that crucial patient information was mistakenly lost during transfers.

Clinical Significance

The research article is crucial to the nursing field, especially for nurses who might be employed by homecare agencies. The study shows the issues which affect the effectiveness of the care offered in homecare. As such, a nurse who gets employed by such agencies will be aware of the challenges to expect and might be able to agree on a fair compensation plan. In addition to this, the study offers information to nursing students on the nursing environment encompassed in homecare in the states of New Jersey, California and Pennsylvania. As such, as a nurse, I will be able to weigh my choices on the place or state to work more effectively to ensure a satisfying work experience. In essence, the study correlates different environments and their effect to the quality of services in homecare and this is crucial information that a nursing student should have to align with a given environment effortlessly.








Jarrín, O., Flynn, L., Lake, E. T., & Aiken, L. H. (2014). Home health agency work environments and hospitalizations. Medical Care, 52(10), 877.

Medicare Payment Advisory Commission. (2012). Report to the congress: Medicare payment policy (Washington, DC: MedPAC, March 2009). The bids submitted by Medicare Advantage plans represent the payment they would require to provide traditional Medicare benefits to their enrollees. .