Inequities in Post-acute Care—a Scoping Review of Patient and Family Caregivers’ Experiences Living in the United States

Research Objectives: To examine and synthesize the lived experiences of historically minoritized older adults’ (e.g., racial and ethnic minority groups, people with lower socioeconomic status (SES), underserved rural communities, sexual and gender minority (SGM) groups, and people with disabilities) and family caregivers’ lived experiences based on their social identities (e.g. race, ethnicity, gender) to access and receive post-acute care. Such an examination allows us to gain a deeper understanding of their efforts to access and receive post-acute care, including the identification of structural factors that inhibit or perpetuate post-acute care disparities.

Design: Scoping Review

Setting: Post-Acute Care

Participants: Included publications had to be published in English in a peer-reviewed journal, or dissertation between January 2003 and January 2022. Eligible studies were (a) conducted in the United States, (b) examined the lived experiences of older adults with a study sample average age of 65 years or older, receiving post-acute care services (i.e., inpatient rehabilitation, skilled nursing facility, home healthcare agencies), and/or the experiences of the family caregiver via qualitative or mixed methods study. In addition, eligible studies included post-acute care participants who self-identified with one of four populations with a history of experiencing health disparities: (a) racially and ethnically minoritized persons, (b) socioeconomically disadvantaged, (c) residing in an underserved rural community, and (d) sexual and gender minoritized persons. The eligible studies also had to disaggregate the experiences of the participants within the sample based on their social identity (e.g., race, socioeconomic status) as a member of one of the four health disparity populations.

Interventions: Not applicable

Main Outcome Measures: The main planned outcome was to examine and report on the current state of the science as it relates to older adult patients and caregivers from minoritized communities seeking to access and receive post-acute care.

Results: The initial search (n=24,332) was reviewed for inclusion producing a final sample (n=2) that reflected patients identifying as (a) Black and African American men and women, (b) low socio-economic status, and (c) White lesbian women. PAC access and care delivery facilitators and barriers spanned domains of the socio-ecological model. There were shared (e.g., discrimination) and divergent themes (e.g., pain management) across populations.

Conclusions: There is a need for PAC evidence representing the lived experiences of patients and caregivers across historically minoritized populations. Failure to capture these voices limits efforts to identify structural racism and discrimination that perpetuate disparities and enhance equity. Our findings suggest additional research is warranted.

Author(s) Disclosures: The authors have no conflicts of interest to declare.