Call to action features respecting self-determination in the home setting, promoting safety culture, fostering learning and improvement, overhauling care coordination, and payment model reform.
"Safe care in the home setting has generally received less attention nationally than safety in hospitals, nursing homes, and ambulatory settings," says the report from the Institute for Healthcare Improvement, "No Place Like Home: Advancing the Safety of Care in the Home."
The IHI report makes a call to action. "We have yet to completely elucidate the nature and prevalence of risks in the home and create optimal ways to improve safety in this setting. Given the increasing proportion of care provided in the home, improving safety in this setting deserves urgent attention."
Home health is a growing healthcare sector. In 2016, there were more than 2 million personal care attendants in home settings, according to the U.S. Department of Labor, with the number projected to increase 40% in the next decade.
The IHI report sets five guidelines to improve home health safety:
In the home setting, self-determination and person-centered care are essential elements for safety, the report says.
"Respect for the sacredness of the home is essential to maintaining dignity. People receiving care at home may not see themselves as 'patients.' For example, people with physical disabilities who receive care at home are not ill. With this in mind, home care workers must avoid 'medicalizing' the home."
Recommendations to foster self-determination and person-centered care include boosting communication with care recipients and family caregivers.
2. Safety culture
Creating and maintaining a safety culture should be a top goal of every organization that provides home health services, the report says.
"Increasing the safety of care in the home requires more than simply collecting prevention strategies and interventions. It requires an overarching commitment to safety."
Promoting the safety of caregivers is essential, the report says.
"The culture of safety and the specific safety practices need to be inclusive, attending to the safety of care recipients and everyone who provides care. … People who provide care in the home are at risk for experiencing emotional or physical harm as they go about their work."
Recommendations to foster a safety culture include guarding the emotional and physical safety of home caregivers.
3. Learning and improvement
An effective learning and improvement system will be crucial in achieving and sustaining home health safety gains, the report says.
There is a dire need to understand and disseminate the fundamentals of home health safety, the report says. "Individuals and organizations must develop or identify effective strategies to improve safety in the home, and to accelerate change they must quickly share these strategies with peers."
The learning process has yet to begin in earnest, the report says.
"We need what we currently do not have: a robust learning system through which to learn, collect, and share data, identify effective interventions using safety science, and spread best practices about safety in the home setting."
Recommendations to support learning and improvement efforts include developing measurement and reporting capabilities.
4. Team-based care and care coordination
The expert panel that crafted the report found poor care coordination is the top clinical concern in home health safety.
"The current healthcare system does not sufficiently enable teamwork among the many professionals involved in a person's care, including nurses, therapists, physicians, social workers, managers, and administrators. Although home care workers often provide care alone, there must be a coordinated team and infrastructure to support them," the report says.
Recommendations to improve care coordination include maximizing the use of community-based resources.
5. Policies and payment models
Policy and payment model reform is needed to boost care coordination and improve service delivery, the report says.
"Current regulations and payment models often increase care fragmentation. In general, services paid via fee-for-service models tend to be siloed, leaving important needs unmet."
Recommendations for reforms include aligning payment models with key home-health goals such as care coordination and whole-person services.
Christopher Cheney is the senior clinical care editor at HealthLeaders.