Differences in average length of stay in home health care may reflect inequality or inefficiency in the delivery of such services. This paper examines the variation in length of stay patterns in home health care by examining the influence of organizational characteristics while controlling for individual characteristics of clients. The 1992 National Home Health and Hospice Care Survey (NHHCS) was used. Organizational behavior theory suggests that organizational characteristics can be investigated to determine differences in organizational behaviors. Three theories (resource dependency, insititutional theory and population ecology) were used to examine the patterns of variability found in the average length of stay among US home health care agencies. Random intercept linear regression models using HLM were developed to assess the effects of organizational form on average length of stay. Approximately 19% of the total variance in average length of stay is associated with factors at the agency level. In random intercepts models that control for client characteristics, it was found that 29% of variance could be explained by agency level variables. Being chain affiliated was marginally associated with reduced average length of stay in home health care. Policy changes and current reform such as the implementation of the Prospective Payment System must consider the impact on home care service provision. Organizational arrangements may result in differential responses which may have unintended consequences for a number of stakeholders in the industry.
Learning Objectives: 1. Discuss the utility of organizational behavior theory to examine home health care service utilization 2. Assess the contribution of multilevel analytical methods to describing home health care use 3. Evaluate the implications of policy change on home health care industry behavior
Keywords: Home Care, Utilization
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.