In April, 2009, the Commonwealth Fund released a study on re-hospitalization indicating that in 2004, 20% of Medicare beneficiaries admitted to the hospital were readmitted within 30 days, and the cost of these admissions was $17.4 billion. Many factors have been found to be associated with re-hospitalized, however, the relationship of social environment factors and re-hospitalization are not well understood. The purpose of this study was to explore the relationship of social environmental factors and re-hospitalization of elderly home healthcare patients. The specific aim is to identify the relationships between re-hospitalization among elderly home healthcare patients and living arrangement, informal primary caregiver, frequency of informal primary care-giving and type of assistance received other than Home Healthcare services.

Medicare mandated OASIS data of elderly Medicare patients from a large Certified Home Healthcare Agency in the northeastern region of the United States was analyzed. Of the 1,312 patients comprising the sample, 257 (19.6%) were re-hospitalized. Pearson correlation analyses, T-test, chi-square, one way ANOVA, Logistic regression, Log-Rank test, Cox regression, linear regression and Cox Proportional-Hazards Regression Model were employed to test the hypotheses.

Key findings of this study include: More than half (63.8%) of the re-hospitalizations occurred within the first 20 days after being admitted to HHC; Functional ability and cognitive functioning predicted re-hospitalization among home health care elderly patients; Social environmental support was positively associated with Self Care Agency and re-hospitalization; Informal caregivers (friends/neighbors and/or paid primary caregiver) are associated with early re-hospitalization.

Findings of this research would allow home care agencies to identify those patients in need of social environmental support and providing support that may prevent unnecessary re-hospitalization. The findings would also inform regulators in the development of reimbursement strategies that avoid costly hospital readmission, and assure patient quality of care.