Pre-Existing Inequality: The Impact of COVID-19 on Medicare Home Health Beneficiaries.

William Cabin

doi:10.1177/1084822321992380

Abstract

There is significant data on the adverse impact of COVID-19 on persons who were poor, minorities, had compromised physical or mental health, or other vulnerabilities prior to the COVID-19 pandemic. A significant portion of the overall Medicare population has such vulnerabilities. The Medicare home health beneficiary population is even more vulnerable than the overall Medicare population based on gender, race, income level, living alone status, and number of chronic conditions. A literature review indicates there is only 1 study on the impact of COVID-19 in Medicare home health on home care workers and none on the impact on home health beneficiaries. The current study is a qualitative study based on interviews of a convenience sample of 48 home care nurses from 9 different home health agencies in New York City between April 1 and August 31, 2020. Six major themes emerged: need for social service supports increased; loneliness and depression increased among patients; physical and mental health conditions became exacerbated; substance use and abuse increased; evidence of domestic violence against patients increased; and there was a limited amount of staff and equipment to care for patients.

Highlights

IntroductionLong et al.[1] found such adverse impacts on gender and racial minorities regarding job losses with Hispanics having the steepest initial job losses; African Americans have recovered just over a third of their jobs lost in the pandemic compared to White Americans recovering more than half of their jobs; women lost more jobs than men; and African American women faced the largest setback in job losses
The purpose of the study presented in this article is to address a gap in the existing literature on the impact of COVID-19 on Medicare home heath beneficiaries.There is significant evidence that the COVID-19 pandemic has had adverse impacts on many individuals who experienced adverse impacts of inequality related to race, gender, age, or income prior to COVID-19
Long et al.[1] found such adverse impacts on gender and racial minorities regarding job losses with Hispanics having the steepest initial job losses; African Americans have recovered just over a third of their jobs lost in the pandemic compared to White Americans recovering more than half of their jobs; women lost more jobs than men; and African American women faced the largest setback in job losses

Summary

Introduction

Long et al.[1] found such adverse impacts on gender and racial minorities regarding job losses with Hispanics having the steepest initial job losses; African Americans have recovered just over a third of their jobs lost in the pandemic compared to White Americans recovering more than half of their jobs; women lost more jobs than men; and African American women faced the largest setback in job losses. Adhikari et al.[2] found infection rate and death rate disparities by poverty level and race in a study of ten combined statistical areas, all of which were urban areas. In comparing high poverty level counties which were substantially White to substantially non-White, they found the non-White counties had an infection rate nearly 8 times higher and a death rate more than 9 times greater. They found that the higher the poverty level of a county, regardless of race distribution, the higher the infection and death rate

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Conclusion