Experts Address National Shortage of Home Care Nurses for Children

June 03, 2019
  • Pediatric home care nursing shortage results in some parents unable to work and children kept in hospital longer, which can amount to millions in excess healthcare spending
  • Shortage of pediatric home care nurses is largely due to inadequate pay and training, with less than 2 percent of Medicaid spending for children with complex medical needs supporting home care
  • Experts recommend more competitive wages for pediatric home care nurses, better training through partnerships with pediatric hospitals, payment for telemedicine support and alignment with initiatives to improve adult home care

Child health experts from Ann & Robert H. Lurie Children’s Hospital of Chicago offer recommendations to address the national shortage of nurses who provide care at home for children with serious chronic health conditions often caused by complications of premature birth. In an article published in the June issue of Health Affairs, Carolyn Foster, MD, MSHS, and colleagues assert that inadequate pay and training for pediatric home care nurses are the major drivers of this shortage, which can cause social, emotional and financial hardship for families. Too often, children cannot be discharged home from the hospital safely because home care nursing support is not available, forcing them to remain in the hospital for weeks or even months until nurses willing and available to do the work can be found.

“Families with children who need medical technologies to survive life-threatening illness are legally entitled to home care services, but frequently they cannot find a nurse to do the work for the long term,” says Dr. Foster, lead author and physician at Lurie Children’s, and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “Parents can find themselves exhausted, staying up night after night for weeks or even years, as they try to keep up with the care their children need to stay out of the hospital.”

With less than 2 percent of Medicaid spending on children with medical complexity to support home care, salaries for pediatric home care nurses fall well below nursing jobs of similar skill levels in hospitals and surgical centers.

“Increasing wages for pediatric home care would likely attract more nurses to this field,” says Dr. Foster. “Greater investment in home care for children would be a better use of healthcare dollars than paying for prolonged hospitalizations that can amount to millions in excess health care spending.”

The authors propose that payment for home care nurses should reflect the level of skill required, with higher wages going to nurses who care for children with more complex needs, such as the use of a home breathing machine. Higher wages also should be directed to nurses working in areas of greatest shortage.

Dr. Foster and colleagues also recommend increased partnerships with children’s hospitals, which would result in better coordination between hospital and home care services for children, as well as better training for home care nurses. Children’s hospitals often provide pediatric-specific training, as for example a program at Lurie Children’s that helps nurses improve their skills in home care for children who are medically fragile and technology dependent.

In addition, the authors stress that reimbursement for telemedicine services, which include use of videoconferencing and remote home monitoring technologies, is needed to extend and support home care of children with chronic illnesses.

“Telemedicine initiatives, such as Lurie Children’s Care Connect, are especially important for the medical support of children and youth who live in remote areas or who are difficult to transport,” says Dr. Foster. “Payment for these services is important, especially since telemedicine has been shown to decrease emergency department use in children with medical complexity, which reduces healthcare costs.”

To advance home care for children, the authors maintain, it will be important for pediatric experts and advocates to be included in government efforts to expand and improve adult home care.

“As the Baby Boomer generation ages and increases policy attention to adult home care, we need to make sure that children who need home care and their parents also benefit from future improvements in this arena,” says Dr. Foster.

On June 4, 2019, Dr. Foster will join adult home care experts and provide the pediatric perspective in the Health Affairs forum “Community Care for High-Need Patients” that will take place in Washington D.C.

The writing of the Health Affairs article was supported by the Lucile Packard Foundation for Children’s Health, Palo Alto, California (Grant No. 2017-00219), with co-authors Rishi Agrawal, MD, MPH, and Matthew Davis, MD, MAPP from Lurie Children’s and Northwestern University Feinberg School of Medicine.

Child health research and advocacy at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through the Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center at Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 212,000 children from 49 states and 51 countries.