The Impact of Hurricane Harvey on Home Health Care Delivery for Medicare Beneficiaries

Hurricanes can profoundly affect the delivery of home health (HH) services. We examined the impact of Hurricane Harvey on HH care in Texas, linking 2017-2018 patient-level Medicare HH claims with county-level data on disaster declarations from the Federal Emergency Management Agency. We used segmented interrupted time series to estimate monthly HH use changes among 142,416 beneficiaries in affected versus non-affected counties immediately after landfall (level change) and in its continued aftermath (trend change). HH nursing use dropped 16% immediately following hurricane and continued to decrease by 0-2%, statistically significant throughout post-Harvey period in the affected counties. However, similar impacts were also observed in non-affected counties. HH therapy use showed similar decreases, but with a smaller magnitude. Beneficiaries with the lowest function experienced significant larger immediate decreases in HH therapy use in the affected versus non-affected counties. Findings suggest the need to enhance mandatory disaster preparedness regulations in Medicare-certified HH agencies.