The Current State of Home Health Care in Puerto Rico

Abstract

Objective: To: (1) assess home health care (HHC) agency coverage across Puerto Rico (PR), and (2) compare PR HHC agencies to all U.S. mainland agencies and a subset of agencies serving counties with high Puerto Rican populations (CHPRP). Methods: HHC coverage in PR was determined by mapping each agency's catchment area using 2022 Home Health Compare and 2020 U.S. Census Bureau ZIP Code Tabulation Areas data. Descriptive statistics on Medicare beneficiaries, agency, and patient characteristics were calculated from 2022 Medicare Geographic Variation, Post-Acute Care and Hospice Provider Utilization and Payment Public Use Files, Home Health Compare, and Provider of Services data. Pearson’s χ2, Fisher’s exact or t-tests were used to compare agencies in PR, on the U.S. mainland, and in CHPRP. Results: Almost all PR ZIP codes are serviced by at least 7 HHC agencies, indicating high levels of coverage. Compared to the U.S. and CHPRP, PR has: 1) a significantly higher proportion of nonprofit/government agencies; 2) higher Medicare Advantage enrollment among beneficiaries; and 3) higher performance in Quality of Patient Care Star rating and fall prevention metrics, but lower performance in timely initiation of HHC, patient flu immunization, pressure ulcer prevention, and Patient Experience Star ratings. Conclusion: Findings reveal a unique home healthcare delivery model that excels in patient improvement metrics, with opportunities to increase performance on patient experience and preventive care measures, further elevating care quality. More research is needed on the underlying factors driving the observed differences, as well as HHC utilization and access among MA enrollees.