(July 18, 2018)—A lack of standard measurement across all homecare services, a lack of standard training and supervision, and a lack of consistently effective communication and care coordination represent some of the most pressing safety problems for homecare, according to a new report from the Institute for Healthcare Improvement (IHI). 

As millions of people are recovering from acute illness or coping with chronic conditions in their homes, care may not always be delivered under the safest of conditions. The IHI's report identifies numerous risks to care recipients and caregivers alike due to the growing complexity of health issues now dealt with at home and the lack of training and preparation.

In "No Place Like Home: Advancing the Safety of Care in the Home," the IHI details five guiding principles for advancing safety and includes case studies of eight programs across the country that are showing results in reducing costs, improving safety and providing more comprehensive care. A wide array of stakeholders would be responsible for enacting the IHI's new recommendations, including homecare workers, home health agency leaders, technology vendors and more. 

The IHI's five guiding principles for advancing safety in the home:

  1. Self-determination and person-centered care are fundamental to all aspects of care in the home setting.
  2. Every organization providing care in the home must create and maintain a safety culture.
  3. A robust learning and improvement system is necessary to achieve and sustain gains in safety.
  4. Effective team-based care and care coordination are critical to safety in the home setting.
  5. Policies and funding models must incentivize the provision of high-quality, coordinated care in the home, and avoid perpetuating care fragmentation related to payment.

“While there is much safety knowledge to draw upon after decades of work in hospitals and other health settings, the challenges to keeping care recipients and their caregivers safe in the home are vastly different than they are in those controlled environments,” Diane Schweitzer, acting chief program officer of the Gordon and Betty Moore Foundation’s Patient Care Program, said via press release. “The guidelines offered in this report are meant to promote safe, person-centered care in the home.”

Care in the home is increasing thanks in part to rising health care costs, an aging population, patient preference, and advances in technology that allow for more complex care to be administered locally. Care recipients benefit by having greater autonomy than they would in a health setting, maintaining family and social ties, and reducing their risk of certain complications (such as sleep disruption). Homecare can also help lower costs of care and allow health professionals to assess related concerns, such as nutrition.

The IHI's report holds that in order to achieve these benefits, caregivers must be cognizant of risks of harm in the home setting as well, such as injuries due to physical hazards or medical equipment, pressure injuries, infections, poor nutrition, adverse events related to medication or other treatment, and potential abuse or neglect. Moreover, health care workers and family caregivers are themselves at risk of physical and emotional harm and burnout.

Download the IHI's new report at ihi.org/no-place-like-home.

For more information about this work and other patient safety programs at IHI, visit ihi.org/patientsafety.