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Pediatric home care nurse shortage causes family hardships


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By Jennifer Thew, RN

Inadequate pay and training are major drivers of a national shortage of pediatric home care nurses, experts from Ann & Robert H. Lurie Children's Hospital of Chicago say in an article published in the June issue of Health Affairs.

Not only does the shortage affect pediatric patients' health, it can also cause social, emotional, and financial hardship for families, according to Carolyn Foster, MD, MSHS, and colleagues. Additionally, children often cannot be discharged home from the hospital safely because home care nursing support is unavailable, forcing them to remain in the hospital for weeks or even months until homecare nurses 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," Foster, the paper's lead author and physician at Lurie Children's, and assistant professor of pediatrics at Northwestern University Feinberg School of Medicine, says in a news release. "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."

Salaries for pediatric home care nurses fall well below those in hospitals and surgical centers as less than 2% of Medicaid spending goes to children with medical complexity to support home care.

"Increasing wages for pediatric home care would likely attract more nurses to this field," Foster says. "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 recommend homecare nurse payment should reflect the skill level required to provide care, with nurses who take on more complex patients receiving higher wages. Additionally, the authors say, nurses working in areas of greatest shortage should receive greater pay.

Foster and colleagues also recommend:

  • Increased partnerships with children's hospitals to better coordinate hospital and home care services
  • Better training for pediatric home care nurses
  • Reimbursement for telemedicine services, including videoconferencing and remote home monitoring technologies, to extend and support home care of children with chronic illnesses

    

"Telemedicine initiatives … are especially important for the medical support of children and youth who live in remote areas or who are difficult to transport," Foster says. "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 say, it is 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," she says.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.