There’s No Place Like Home: States with the Best Home Health Care

We can be not only our happiest, but our healthiest, right at home.

Healthcare is not limited to in-hospital treatment. Under both Medicare and Medicaid, eligible patients have access to receive healthcare from home health teams. These home services increase access to acute care for individuals who are homebound or have limited mobility. According to the U.S. Centers for Medicare & Medicaid Services, these home care agencies have services that include a variety of options such as intermittent skilled nursing care, physical and occupational therapies, speech-language pathology services, medical social services, and part-time aide services.

Home health care is different from home and personal care that is also often covered by government insurance. While home and personal care are essential to the wellbeing of our family members and loved ones, they generally consist of non-medical or custodial home visits. Home health care teams, likewise, are made up of trained medical professionals and nursing assistants who provide tailored, quality care plans in a patient’s home. For patients who do not have family caregivers or live in an assisted living facility, but wish to maintain their independence at home, home health care services can keep them healthy and safe. These options are especially important in the pandemic era, as the elderly are particularly vulnerable and should avoid non-emergency hospital settings as much as possible.

Home health teams are an integral yet often overlooked aspect of public health in America, as home health aides work tirelessly to provide care services for patients in their own homes. Pointing the spotlight on home care services increases recognition of this underappreciated component of accessible healthcare. The data science team at Insurify was inspired to dig deeper into the effectiveness of home health care providers and recognize the states with the highest performing home health teams in the nation.

Insights

• National averages. Across the United States, the average home health team performance score was 89.270. The average patient improvement score was 81.216. The average number of Medicare beneficiaries per state was 796,849; their average share of a state population was 18 percent.

• High overall performance. The national average indicates that overall, home health team performance scores were generally high. Washington DC’s home health team performance score of 84.425 was the lowest in the nation. For patient improvement measures, Alaska had the lowest score of any state, at 66.000.

• Not all home health programs are created equal. A critical disclaimer to the national evaluation of home health programs is that home health programs do not operate uniformly across all states. Because Medicare and Medicaid receive funding from both the federal and state levels, support for specific home health services are at the state’s discretion, resulting in variation of program capacity and availability between states. States can have a variety of home health programs, and within states, different counties may have access to specific programs over others.

• Age is more than just a number. While home health care is available to Medicare and Medicaid recipients (who, in theory, can be any age), home health care is mostly used by and targeted towards elderly patients who are 65 years old or over. Likewise, home health team performance score is positively correlated with the percent of the state’s population that is over 65, albeit not significantly. This finding suggests that the higher a state’s share of the population is over 65, their overall home health team score may skew higher.

Methodology

The data science and research team at Insurify, a home insurance comparison platform, studied data from Data.Medicare.gov to determine home health care performance in each state. They calculated the home health team performance score by taking the average of multiple home health team conduct measures that were recorded for each state. For each measure, states recorded the average rating (from 0-100, with higher numbers being more satisfactory) reported by their residents. These measures include how timely the home health care team attended to patient needs; as well as how often home physicians checked in with patients regarding falls, depression, and vaccination histories for pneumonia and the flu. Additionally, metrics for the quality of the home health team’s communication with the patient; the level of professionalism performed by the home health team; and whether the patient would recommend their home health agency to friends and family were factored in.

Similarly, the patient improvement score was determined as a composite by taking the average of multiple measures regarding patient improvement from home healthcare. These measures include how often patients saw improvements concerning walking, mobility, getting out of bed, bathing, breathing, and how often a patient’s wounds healed after an operation. The statistics for state-level Medicare beneficiaries come from the Medicare Data for the Geographic Variation Public Use File, available through the Center for Medicare and Medicaid Services. The share of Medicare beneficiaries by the total state population is from the Kaiser Family Foundation’s 2018 Medicare Enrollment statistics.

States with the Best Home Health Care

10. Kansas

• Average home health team performance score: 90.920

• Average patient improvement score: 81.250

• Number of Medicare beneficiaries with Parts A & B (2018): 402,718

• Medicare beneficiaries as a share of the total population (2018): 18%

We’re kicking off in the heart of the midwest with Kansas’s strong home health team performance score of 90.92. Kansas’s scores for home health team performance and patient improvement are slightly above (by 2 points) or equal to the averages for the nation, respectively.  The case of Kansas demonstrates how tight the ranges of these national measures are. However, given that Kansas’s share of Medicare beneficiaries within its population is also equivalent to the national average of 18 percent, its higher home health team performance score is still something to be proud of.

9. Arkansas

• Average home health team performance score: 90.950

• Average patient improvement score: 83.750

• Number of Medicare beneficiaries with Parts A & B (2018): 490,161

• Medicare beneficiaries as a share of the total population (2018): 21%

Arkansas is ninth in the nation for its home health team performance, beating out Kansas by a mere 0.03 points. With a share of Medicare beneficiaries that is 17 percent above the national average, Arkansas has one of the sixth-highest proportions in the nation (notably, equal to and tied with ten others). Arkansas has both specific Medicaid programs and waivers that allow eligible patients to participate in a cash-to-counseling model, meaning that patients can make independent choices for their care using a monthly allowance provided by these programs. Arkansas’s stellar home health team performance and patient improvement scores both suggest that their programs are successful and effective.

8. Louisiana

• Average home health team performance score: 90.950

• Average patient improvement score: 83.770

• Number of Medicare beneficiaries with Parts A & B (2018): 626,227

• Medicare beneficiaries as a share of the total population (2018): 19%

Down by the bayou, Louisiana’s home health programs are making a splash. As eighth in the nation, with a home health team performance score of 90.95, it’s clear that homebound patients in Louisiana are feeling adequately supported and aided by their home healthcare professionals. Because Louisiana and Arkansas are technically tied for home health team performance, Louisiana’s comparatively higher patient improvement score was factored in to define its ranking. While only slightly above the national average in its population’s share of Medicare beneficiaries, Louisiana’s high scores across the board are worthy of our recognition.

7. New Hampshire

• Average home health team performance score: 91.125

• Average patient improvement score: 79.900

• Number of Medicare beneficiaries with Parts A & B (2018): 186,569

• Medicare beneficiaries as a share of the total population (2018): 22%

It’s no surprise that New Hampshire should find its place in the ranks of the highest performing home health teams in the nation. New Hampshire has a comparatively older population, with 20.5% of its residents over the age of 65, according to the U.S. Census Bureau. Additionally, New Hampshire is fifth in the nation for its population’s share of Medicare beneficiaries, which is in line with the insight that states with older populations may have scores that skew higher for home health team performance. New Hampshire’s patient improvement score is about two percent below the national average, perhaps in part due to existing conditions of its state-specific demographics. However, New Hampshire’s stats are excellent overall, making it an ideal place to “live free.”

6. Kentucky

• Average home health team performance score: 91.175

• Average patient improvement score: 82.220

• Number of Medicare beneficiaries with Parts A & B (2018): 694,652

• Medicare beneficiaries as a share of the total population (2018): 21%

Break out your derby hats for Kentucky’s home health teams! Kentucky’s score of 91.175 is the sixth highest in the nation, and its patient improvement score of 82.22 comes in at fourteenth. Like Arkansas and Kansas, Kentucky’s share of Medicare beneficiaries is also the sixth-highest in the nation, at three percentage points above average. Kentucky’s Medicaid coverage encompasses multiple home care options, including different waivers for aged and disabled populations. Kentucky’s A-rating for caring for its homebound populations is undoubtedly well-deserved.

5. West Virginia

• Average home health team performance score: 91.180

• Average patient improvement score: 84.380

• Number of Medicare beneficiaries with Parts A & B (2018): 363,759

• Medicare beneficiaries as a share of the total population (2018): 25%

Moving up in both altitude and home health team performance, the Mountain State holds the fifth spot in the rankings for states with the best home health care programs. According to the U.S. Census Bureau, West Virginia has the third-highest elderly population in the nation, with 20 percent of its population over the age of 65 and a median age of 42.8. This fact follows the trend of higher home health team scores corresponding to comparatively older populations, due to the targeting of elderly patients in home health settings. Additionally, West Virginia’s share of Medicare beneficiaries is one of the highest in the nation. However, the state’s success in its patient improvement and home healthcare metrics is still one to be specially acknowledged.

4. South Carolina

• Average home health team performance score: 91.230

• Average patient improvement score: 82.280

• Number of Medicare beneficiaries with Parts A & B (2018): 687,742

• Medicare beneficiaries as a share of the total population (2018): 21%

South Carolina is fourth in the nation for its excellent home health team performance, boasting a score of 91.23. With a relatively high share of statewide Medicare beneficiaries, equal to those of Kansas, Arkansas, and Kentucky at 21 percent, homebound patients in South Carolina evidently benefit and improve from their home health teams’ care. South Carolina also has the tenth-oldest population compared to other states, with 17.7 percent of residents over the age of 65. Based on the state’s high-scoring results in both home health team performance and patient improvement, South Carolina is not only meeting the expectation for at-home patient care, but exceeding it.

3. Alabama

• Average home health team performance score: 91.260

• Average patient improvement score: 85.730

• Number of Medicare beneficiaries with Parts A & B (2018): 773,340

• Medicare beneficiaries as a share of the total population (2018): 21%

With a performance score of 91.26, Alabama is our bronze winner for home health program efficacy. The state’s impressive 85.73 score for patient improvement comes in at second in the nation as well. By now, it’s clear that many of the states on the list are in the upper echelon for their proportion of Medicare beneficiaries within the population. Alabama is not an exception to this pattern, as its share is 21 percent, the same as four previous states on this list (Kansas, Arkansas, Kentucky, and South Carolina). This trend that Alabama follows underscores how important accessibility to diverse healthcare options is for patients on Medicare — it seems as though homebound patients are overwhelmingly satisfied with the care provided by their home health teams.

2. Mississippi

• Average home health team performance score: 91.325

• Average patient improvement score: 85.800

• Number of Medicare beneficiaries with Parts A & B (2018): 464,895

• Medicare beneficiaries as a share of the total population (2018): 20%

Continuing through the south, Mississippi holds the second-highest score for home health team performance nationwide. Equally noteworthy, Mississippi’s patient improvement score is the highest of any U.S. state. Home health teams must be doing something right in this state, as these high statistics demonstrate successful convalescent care. Props to the Magnolia State for helping lead the nation in home health team performance and strong patient outcomes.

1. South Dakota

• Average home health team performance score: 91.525

• Average patient improvement score: 78.230

• Number of Medicare beneficiaries with Parts A & B (2018): 126,751

• Medicare beneficiaries as a share of the total population (2018): 20%

At the top of the nation, South Dakota gets the gold for its outstanding home health care administration. While surprisingly scoring slightly lower than average for patient improvement measures, South Dakota’s outcomes are still impressive. For a state with the fifth-lowest population density in the nation, it makes sense that home health care may be a more enticing option for residents, who are more likely to live farther away from healthcare facilities. Still, South Dakota can take this win as a recognition of its strong adaptability to its population’s needs.

Conclusion: Limitations and Avenues for Future Research

While Insurify’s study aims to spotlight home health care as an essential component of healthcare accessibility and point to states that perform well on a composite of multiple evaluatory metrics, these rankings are not exhaustive measurements of policy success across all populations.

• Not all states are funded equally. Our analysis does not account for the moderating factor of state funding. As noted, Medicare programs are controlled in part by state funding and legislature, meaning that variation across the nation in access to specific Medicare programs can be vast. Future research and analysis could directly engage with the public economic aspect of Medicare by examining state spending trends in relation to home health program effectiveness.

• Healthcare workers’ welfare matters. This study focused primarily on patient outcomes and home health team’s efficacy in producing their success. However, as Medicare’s home health programs vary state by state, home healthcare worker conditions follow. For future analysis, studies focusing on the employee side of home health care agencies could shed light on how home health workers’ welfare affects their job performance and patient outcomes.

• Potential disparities in patient care. It’s no secret that there are disparities in patient outcomes based on identifying markers such as race, class, gender, sexual orientation, body size, and socioeconomic status. Reports from sources such as the Kaiser Family Foundation, the Medicare & Medicaid Research Review, and countless others have noted these significant differences. This study on home health care did not factor in demographic information of individuals and could benefit from these breakdowns in future analyses.

If you have questions or comments about this article, please contact insights@insurify.com.