{"id":11435,"date":"2019-11-06T08:00:59","date_gmt":"2019-11-06T13:00:59","guid":{"rendered":"https:\/\/advertise.nurse.com\/?p=11435"},"modified":"2025-08-12T12:22:36","modified_gmt":"2025-08-12T16:22:36","slug":"home-care-nursing-shortage-negative-impact-patients","status":"publish","type":"post","link":"https:\/\/www.nurse.com\/solutions\/blog\/home-care-nursing-shortage-negative-impact-patients","title":{"rendered":"Home Care Nursing Shortage Has Negative Impact on Patients"},"content":{"rendered":"

The nursing shortage places a burden on patients who need home care and the recruiters who work to fill their positions.<\/h2>\n

This is because the home care nursing shortage<\/a> is widespread. However, some locations have been hit harder than others.<\/p>\n

Complex pediatric patients and their families, for example, are often on the receiving end of its devastating effects, said Garey Noritz, MD<\/a>, internist and pediatrician, section and division chief of the Complex Health Care Program, and director of the Comprehensive Cerebral Palsy Program at Nationwide Children\u2019s Hospital.<\/p>\n

Factors contributing to the home care nursing shortage<\/h3>\n

There are several reasons why the home care nursing shortage is severe, according to Nortiz, who also is a professor of pediatrics at Ohio State University.<\/p>\n

    \n
  1. Significant pay disparities<\/a> between hospital-based versus home care nursing jobs (hospitals pay more<\/em>).<\/li>\n
  2. A shortage of nurses overall and the availability of higher paying positions elsewhere.<\/li>\n
  3. Home care nursing can be isolating due to lack of socialization with colleagues.<\/li>\n
  4. Complex pediatric patients are hospitalized frequently and, when they are admitted, their assigned home care nurse is temporarily out of work (loss of income<\/em>).<\/li>\n<\/ol>\n

    \u201cIt\u2019s not difficult to hire RNs<\/a>, but it can be challenging to find experienced RNs to care for children with special needs,” said Nick Provost, president of New Jersey Total Care<\/a> of Paramus, N.J. “Many nurses don\u2019t stay in home care \u2014 it can be a revolving door. The pay rates are lower in home health due to the lower reimbursement rates that kicked in since 2014 in New Jersey with the Affordable Care Act.\u201d<\/p>\n

    In-home nursing shortage for pediatric patients<\/h3>\n

    Noritz said the shortage of home care nurses typically leads to longer hospital lengths of stay for medically complex children. \u201cIt impacts our ability to get these kids home,<\/a>” he said.<\/p>\n

    \"The<\/a>Researchers found some key findings from a 12-month multi-site study conducted in Minnesota of children with medical complexity, who were discharged with home health.<\/p>\n

    \u201cThe average child going home for the first time with an order for in-home nursing care spent nearly 54 additional days<\/a> on average in the hospital due to the lack of in-home nurses to provide care after discharge,\u201d said Roy Maynard, MD, FAAP, medical director at Pediatric Home Service<\/a> based in Roseville, Minn., a provider of high-tech home care for children with medical complexities in Minnesota and Wisconsin.<\/p>\n

    A cost analysis conducted in this study also revealed \u201cdelayed discharge resulted in an added cost of approximately $170,000 per patient and an overall increased cost of $5 million to the healthcare system in Minnesota alone,\u201d said Maynard, who also is a former executive committee member for the American Academy of Pediatrics Section for Home Care, and a retired neonatologist and pediatric pulmonologist from Children\u2019s Hospital in Minneapolis, Minn.<\/p>\n

    Findings of this same study \u2014 conducted by Maynard and his colleagues \u2014 also discovered the pediatric population with tracheotomies and ventilators is increasing.<\/p>\n

    \u201cOne reason for the increased number of children with medical complexity is better cardiac surgical techniques for children,” the study stated. “More kids are saved. However, they\u2019re dependent on tracheotomies and ventilators. Their survival rates have increased, they\u2019re living longer and their quality of life has improved \u2014 but they\u2019re not liberated from their dependence on medical technologies.\u201d<\/p><\/blockquote>\n

    Getting in-home nursing care approved by a patient\u2019s insurance and in a timely manner can be challenging, as well.<\/p>\n

    \u201cOnce approved, the second hurdle is finding nurses available to staff all of the hours that have been approved,” Noritz said.<\/p>\n

    The lack of approved hours by insurance along with the shortage of in-home nurses requires parents pick up the slack.<\/p>\n

    \u201cThe typical number of hours approved for patients on a ventilator is only eight hours per day,” Nortiz said. “This requires us to always train the parents.\u201d<\/p><\/blockquote>\n

    The impact on the families of children with medical complexity also is significant.<\/p>\n

    \u201cThis causes increased stress on the family as they try to provide care to their child,” Maynard said. “Many parents are unable to work. A parent cannot work if they have to be home providing care. This decreases their earnings and increases financial burdens.\u201d<\/p>\n

    \"\"<\/a><\/p>\n

    The elderly are negatively impacted too<\/h3>\n

    The lack of in-home nurses also adversely affects the elderly, said Ron Ordona, DNP, FNP-BC, chairman of the Gerontological Advanced Practice Nurses Association’s<\/a> House Calls Special Interest Group and a primary care medical house call provider for home-bound seniors with Senior Care Clinic House Calls<\/a>, based in Lincoln, Calif.<\/p>\n

    Ordona, who is board certified in gerontology and family practice, said in addition to the demand for nurses in general to work in home care, there is a great need for home-based primary care providers for home-bound elderly patients.<\/p>\n

    \u201cA 2018 report prepared for the Association of American Medical Colleges, projected a primary care shortage of between 14,800 and 49,300 physicians\u00a0by 2030. Nurse practitioners can help fill the gaps as primary care providers, including the provision of home-based primary care<\/a> for home-bound elderly patients,\u201d said Ordon, clinical faculty at Boise State University and volunteer clinical faculty and founding donor at UC Davis Betty Irene Moore School of Nursing.<\/p><\/blockquote>\n

    The shortage of in-home nurses and home-based primary care providers for the elderly leads to the exacerbation of chronic conditions, said Ordona.<\/p>\n

    \u201cThis creates stress for family members and assisted living staff, and results in an increased use of the emergency department for primary care access, costing an average of $2,500 to $5,000 per visit,\u201d Ordona said.<\/p>\n

    Strategies to resolve the home care nursing shortage<\/h3>\n

    Ordona suggests three ideas to address the home care nursing shortage<\/a>:<\/p>\n