1. Osakwe, Zainab Toteh PhD, MSN, RN, NP

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Emphasis has been placed on the social determinants of health in home care with the addition of items A1010 (Race), A1005 (Ethnicity), A1250 (Transportation), and A1110 (Language) to the Outcome and Assessment Information Set (OASIS-E), which were implemented in January 2023 (Centers for Medicare and Medicaid Services, 2022). This is important as literature points to disparities in outcomes of patients receiving home care (Fashaw-Walters et al., 2022), and the population of racial/ethnic minority homebound people has increased with the COVID-19 pandemic (Ankuda et al., 2021). Home care provides a unique opportunity to assess social determinants of health such as education, financial stress, and neighborhood. Unlike hospital or nursing home care, relatively few studies are in progress in home care to identify interventions to address these social determinants of health.


Concerns are growing among clinicians about how the race and ethnicity questions, if not well received by patients, might impact patient-clinician relationships. Home care leaders need to invest time in helping clinicians determine the best approach to pose questions about race and ethnicity. The role of a home care clinician requires a high level of interpersonal skills and cultural sensitivity to build relationships with patients that can generate revisits and continuity of care. Skill attainment in cultural sensitivity requires ongoing training and refinement (Rhodes et al., 2015). Home care clinicians may feel insufficiently trained in the delivery of culturally sensitive care, and uncomfortable discussing sensitive issues that may arise when the question of race/ethnicity is raised.


The new OASIS-E questions offer an opportunity to gain feedback from clinicians about collecting data on race and ethnicity. It is important to help clinicians better understand that, asking patient's question about their self-reported race and ethnicity, and even their preferred language of communication is an important effort toward equity in health outcomes. Home care leaders and administrators should provide a forum for clinicians to provide feedback about their experiences with these questions.


Ongoing education is vital for clinicians to learn about social determinants of health and how to navigate discussions that may arise when collecting data from patients. They can ask, "which categories best describes your race?" If patients feel uncomfortable with these questions, the OASIS-E guidance recommends saying to patients, "We want to make sure that all our patients get the best care possible, regardless of their ethnic background" (Centers for Medicare and Medicaid Services, 2022). Agency leadership should seek feedback from clinicians about specific challenges they experience when asking patients about race and ethnicity. Such information would inform the development of education tailored to the unique needs of clinicians in agency.




Ankuda C. K., Leff B., Ritchie C. S., Siu A. L., Ornstein K. A. (2021). Association of the COVID-19 pandemic with the prevalence of homebound older adults in the United States, 2011-2020. JAMA Internal Medicine, 181(12), 1658-1660. [Context Link]


Centers for Medicare and Medicaid Services. (2022). The draft guidance manual for the Outcome Assessment Information Set Version E (OASIS-E).[Context Link]


Fashaw-Walters S. A., Rahman M., Gee G., Mor V., White M., Thomas K. S. (2022). Out of reach: Inequities in the use of high-quality home health agencies. Health Affairs, 41(2), 247-255. [Context Link]


Rhodes R. L., Batchelor K., Lee S. C., Halm E. A. (2015). Barriers to end-of-life care for African Americans from the providers' perspective: Opportunity for intervention development. The American Journal of Hospice and Palliative Care, 32(2), 137-143. [Context Link]