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Race and home and community based care: a preliminary study of the non-elderly, physically disabled in Philadelphia
Thesis

Race and home and community based care: a preliminary study of the non-elderly, physically disabled in Philadelphia

Katharine Vengraitis
Master of Public Health (M.P.H.), Drexel University
May 2012
DOI:
https://doi.org/10.17918/etd-3933
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Vengraitis_Katharine_20121.85 MB
PDF Project Access upon request, Email title, URL, or DOI to archives@drexel.edu
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Vengraitis_Katharine_2012_Suppl11.04 MB
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Abstract

Community-based care Physically Disabled Persons Public Health
Objectives: A recent study has shown that the increase in elderly racial and ethnic minorities in nursing homes has far outpaced their increase in the general population, possibly as a result of unequal access to home and community based alternatives. These alternatives, provided through Medicaid 1915(c) Home and Community-Based Services (HCBS) waivers, allow eligible individuals to receive care outside of institutional settings. The Pennsylvania Health Law Project (PHLP) is interested in HCBS waivers because of the disproportionate impact of trauma and injury on low-income, young minorities and inquired if a similar pattern of disparate use was evident in the non-elderly physically disabled in Philadelphia. Methods: Pennsylvania Department of Public Welfare enrollment data was analyzed for three waivers for state fiscal years, 2005-2011. Chi-square goodness of fit tests were used to determine the statistical significance of the observed pattern compared to baseline data. Semi-structured interviews with health care providers and experts provided valuable insight on the needs of this population, barriers and facilitators to enrollment and the role of race in HCBS use. Results: When analyzed by overall enrollment, gender, age (18-29 and 30-59), gender and age, and by specific waiver program, the percentage of African Americans using these waivers is consistently far higher than that of all other racial and ethnic groups. This difference is statistically significant (p<.001) compared to Philadelphia County demographics for nursing homes, Medical Assistance enrollment and residents of Inglis House, a Philadelphia skilled nursing facility for non-elderly physically disabled adults. Enrollment in the more suburban counties of the five-county area revealed an inverse pattern suggesting that Philadelphia has a larger population of low-income, physically disabled non-elderly minorities. Conclusions: Growing waiver use among this population highlights the need to reduce barriers to enrollment that may mask unmet need, as well as the need to monitor quality, which appears to be a greater concern than access. Advocacy and direct representation can focus on strengthening these increasingly important programs through collaboration with the home health aide industry, as well as with the state given possible discrepancies between authorized and received units and the impact of potential budget cuts.

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