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Does Paid Versus Unpaid Supplementary Caregiving Matter in Preventable Readmissions?
Hsueh-Fen Chen, PhD; Taiye Oluyomi Popoola, MBBS, MPH; and Sumihiro Suzuki, PhD

Does Paid Versus Unpaid Supplementary Caregiving Matter in Preventable Readmissions?

Hsueh-Fen Chen, PhD; Taiye Oluyomi Popoola, MBBS, MPH; and Sumihiro Suzuki, PhD
Home health beneficiaries with diabetes using paid supplementary caregivers had 68% higher hazards of readmission due to urinary tract infection than those with unpaid supplementary caregivers.
Despite the study limitations, our findings have clinical and policy implications. For clinical implications, paid and unpaid supplementary caregivers are critical partners for home health professionals. Inviting supplementary caregivers to initiate care plans and assuring their competence to meet Medicare home health beneficiaries’ health needs becomes critical in the home health industry as the Medicare program is moving toward value-based purchasing and penalizing home health agencies with high preventable readmissions. For policy implications, our findings showed that our society heavily relies on unpaid supplementary caregivers to provide care to meet their loved ones’ health needs and that beneficiaries with unpaid supplementary caregivers had lower risks of readmission due to UTIs than those with paid supplementary caregivers. Policies that support unpaid supplementary caregivers are critical to help caregivers assist their loved ones and prevent them from using expensive hospital resources.36,37


The authors thank Dr Sharon Homan’s contribution in the early stage of this project.

Author Affiliations: Department of Health Policy and Management  (HFC), College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR; Department of Biostatistics and Epidemiology, School of Public Health (SS), University of North Texas Health Science Center, Fort Worth, TX; Department of Health Policy and Management, School of Medicine, University of Kansas Medical Center (TP), Kansas City, KS.

Source of Funding: This study was funded by the Junior Faculty Seed Fund at the University of North Texas Health Science Center (UNTHSC). The views expressed in this publication are the views of the authors and do not necessarily reflect the views of UNTHSC. 

Author Disclosures: The manuscript was accepted when Dr Chen was affiliated with UNTHSC and was published when Dr Chen was affiliated with the University of Arkansas for Medical Sciences. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. 

Authorship Information: Concept and design (HFC); acquisition of data (HFC); analysis and interpretation of data (HFC, SS); drafting of the manuscript (HFC, TP, SS); critical revision of the manuscript for important intellectual content (HFC, TP, SS); statistical analysis (HFC, TP); obtaining funding (HFC); and administrative, technical, or logistic support (HFC). 

Address Correspondence to: Hsueh-Fen Chen, PhD, Department of Health Policy and Management, University of Arkansas for Medical Sciences 4301 West Markham St, Mail Slot 820-12 Little Rock, AR 72205. E-mail:

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