Cultural Competence in Home Healthcare Nursing: Disparity, Cost, Regulatory, Accreditation, Ethical, and Practice Issues

Abstract

Home healthcare patients, who are members of minority, marginalized, or vulnerable patient populations, are at risk for healthcare disparities. Inadequate attention to the needs of the many different types of diverse patient populations seen by home health agencies could compromise an agency’s outcome indicators, reimbursement in value-based payment programs and responsibility to deliver equitable quality care. Culturally competent home health nurses may have a role in decreasing disparities and improving patient outcomes. This article discusses the incidence of disparities in home health care and highlights literature about the economic, regulatory, accrediting, policy, social justice, and ethical issues surrounding disparate and inequitable care for home healthcare patients. Patients in need of culturally competent care include those characterized by diversity related to race, ethnicity, language, religion, socioeconomic status, sexual orientation, gender identification, mental and physical disabilities, and stigmatized diagnoses (e.g., obesity and substance abuse). Home healthcare nurses who strengthen the cultural competence of their care may be able to decrease the incidence of disparate outcomes. By investing in the cultural competence of their home healthcare nurses, agencies may strengthen their commitment to their missions and the financial health of their agencies.

Home Health Nurses’ Journey Toward Culture-Sensitive/Patient-Centered Skills: A Grounded Theory Study

“…Home healthcare patients are at risk of outcome disparities when they are members of minority, marginalized, or vulnerable patient populations. [1][2][3][4][5][6][7][8][9][10] In the United States, disparities among these high-risk populations have been repeatedly documented across multiple settings. 11 Home health disparities have been associated with adverse events, re-hospitalization, ineffective disease and medication management, poor functional outcomes, and decreased patient satisfaction.…”

“…[12][13][14][15][16][17] Disparities may indicate that regulatory, accreditation, and professional standards for high-quality, equitable care are not being met. 4 In addition, disparities cost billions of dollars to the healthcare system and society every year. 18 Disparities are indicators of poor-quality, unequitable care.…”

Cultural Factors and Social Changes Affecting Home Healthcare in Iran: A Qualitative Study

“…8 Therefore, without a deep understanding of the socio-cultural context, it is impossible to define competent HHC. 9 Shahsavari et al 10 revealed that the socio-cultural context is an important factor in the acceptance of the HHC by patients and their families. Hence, professionals cannot provide effective care if they are not sensitive to patients’ socio-cultural values.…”

“…11 Indeed, healthcare disparities are associated with inadequate sensitivity to the cultural needs of the minority patients endangering their health and well-being. 9…”

Transcultural Nurse Views on Culture-Sensitive/Patient-Centered Assessment and Care Planning: A Descriptive Study

“…CCC is needed not only for patients of diverse races and ethnicity but also for patients in other minority and vulnerable groups. Populations whose cultural norms or lifeways differ from the “expected” norms of the majority population (e.g., due to age, gender, sexual orientation, gender identification, socioeconomic status, education, occupation, mental/physical disability, stigmatized diagnoses) also need nurses who can provide CCC to meet their particular health care needs (Narayan, 2020).…”