Parents of children requiring invasive home mechanical ventilation (IMV) rely on, and are expected to manage, complex home health nursing care teams. However, ubiquitous shortages in the pediatric home healthcare workforce leave most families with incomplete nursing support, with negative impacts on child and family well-being. Parents report feeling stressed, overwhelmed, and unsupported by community healthcare services. Parent-to-parent support programs in other populations of children with disabilities have been shown to embolden parents with practical solutions, emotional support, and social connectedness. We designed a novel parent-to-parent coaching model for parents of children with IMV who did not have established home health nursing to empower parents to expand and manage new home health nursing teams. Ten mothers of children awaiting hospital discharge or home without complete nursing support were recruited through a state-wide program. Mothers participated in telephone coaching sessions with experienced family caregivers that included topics related to establishing and managing home health teams and preparing the home for home health nursing. Families were in the program on average 6 months with a median of 11.5 calls with their coach. At the study exit, the majority of families expanded nursing staff and had their child in the family home with the support of home health nursing. Two themes were identified in exit interviews: (1) mothers appreciated specific resources shared by coaches and (2) mothers felt grateful for the emotional support coaches provided, including sharing common experiences and feeling validated. Parents reported that coaches provided unique education and support not provided through existing systems. Parent-to-parent coaching for families of children with IMV may potentially help to reduce home health nursing gaps while also empowering and supporting socially-isolated parents.
The International Home Care Nurses Organization (IHCNO) emerged in response to a recognized need for a dedicated international professional organization focused on nursing care in the home and community. This historical narrative review examines the organization's development from its early origins in 2008 through 2026. It analyzes how a volunteer-led specialty network contributed to the global advancement of home healthcare nursing. Archival records, peer-reviewed publications, conference materials, organizational documents, and oral-history feedback from founding and current leaders were reviewed and synthesized. Findings highlight IHCNO's progression from a journal-anchored grassroots initiative into an incorporated international professional association with five global conferences, international guidelines and standards, a research grant program, and strategic partnerships supporting education, research, and professional recognition. The organization's history illustrates how distributed volunteer leadership, strategic publication partnerships, and deliberate infrastructure development can strengthen specialty identity and foster international collaboration. As care increasingly shifts into homes and communities worldwide, IHCNO offers an example of how nursing organizations can support practice, research, and policy in evolving models of home-based care.
More than 3 million Medicare beneficiaries use home healthcare annually. The prevalence of neighborhood disadvantage for community-living older adults is 15.8%. Medicare's Home Health Value-Based Purchasing (HHVBP) model quality measures for home health were initiated in 2016. There is little data on the quality of care received in home health by vulnerable beneficiaries living in disadvantaged neighborhoods. The purpose of this literature review was to analyze the quality of home healthcare (HHC), as determined by the five-star rating system or other quality measures, based on neighborhood socioeconomic disadvantage levels. A literature search of four databases was conducted. Two researchers independently assessed each study for methodological quality using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Eight articles met the inclusion criteria and found that older adults living in lower socioeconomic status neighborhoods receive HHC from agencies that receive lower star ratings and lower quality of care.
More than 3 million Medicare beneficiaries use home healthcare annually. The prevalence of neighborhood disadvantage for community-living older adults is 15.8%. Medicare's Home Health Value-Based Purchasing (HHVBP) model quality measures for home health were initiated in 2016. There is little data on the quality of care received in home health by vulnerable beneficiaries living in disadvantaged neighborhoods. The purpose of this literature review was to analyze the quality of home healthcare (HHC), as determined by the five-star rating system or other quality measures, based on neighborhood socioeconomic disadvantage levels. A literature search of four databases was conducted. Two researchers independently assessed each study for methodological quality using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Eight articles met the inclusion criteria and found that older adults living in lower socioeconomic status neighborhoods receive HHC from agencies that receive lower star ratings and lower quality of care.
Urinary tract infections (UTIs) are among the most common bacterial infections, particularly within the older adult population receiving care from home health professionals. Vigilant monitoring of UTIs as well as catheter-associated urinary tract infections (CAUTIs) and strategic program development to mitigate their incidence have become critical priorities. These types of infections are regarded as an important indicator for assessing the quality of care delivered by home care agencies. This article examines the development and implementation of an interdisciplinary education program aimed at preventing UTIs and CAUTIs among home healthcare patients. Recognizing the heightened risk of infection in individuals requiring catheters and the unique challenges presented in the home health setting, the authors collaborated across nursing, occupational therapy, and wound/ostomy care specialties to create a comprehensive curriculum. The program emphasizes evidence-based practices, such as proper catheter care, hand hygiene, early recognition of infection symptoms, and patient/caregiver engagement. Training sessions were tailored to address the diverse backgrounds of home healthcare professionals and patients, ensuring accessibility and practical application in daily routines. Preliminary outcomes suggest improved knowledge retention among staff and enhanced patient safety, with early data indicating a reduction in infection rates. By leveraging expertise from multiple disciplines, the initiative demonstrates how home health agencies can proactively address infection prevention, ultimately improve patient outcomes and reduce healthcare costs.
Parents of children requiring invasive home mechanical ventilation (IMV) rely on, and are expected to manage, complex home health nursing care teams. However, ubiquitous shortages in the pediatric home healthcare workforce leave most families with incomplete nursing support, with negative impacts on child and family well-being. Parents report feeling stressed, overwhelmed, and unsupported by community healthcare services. Parent-to-parent support programs in other populations of children with disabilities have been shown to embolden parents with practical solutions, emotional support, and social connectedness. We designed a novel parent-to-parent coaching model for parents of children with IMV who did not have established home health nursing to empower parents to expand and manage new home health nursing teams. Ten mothers of children awaiting hospital discharge or home without complete nursing support were recruited through a state-wide program. Mothers participated in telephone coaching sessions with experienced family caregivers that included topics related to establishing and managing home health teams and preparing the home for home health nursing. Families were in the program on average 6 months with a median of 11.5 calls with their coach. At the study exit, the majority of families expanded nursing staff and had their child in the family home with the support of home health nursing. Two themes were identified in exit interviews: (1) mothers appreciated specific resources shared by coaches and (2) mothers felt grateful for the emotional support coaches provided, including sharing common experiences and feeling validated. Parents reported that coaches provided unique education and support not provided through existing systems. Parent-to-parent coaching for families of children with IMV may potentially help to reduce home health nursing gaps while also empowering and supporting socially-isolated parents.
Within-group (pre-post) designs are commonly employed in home healthcare research because patient and professional study populations present with heterogeneous characteristics, recruitment is often challenging, and well-matched control groups are often infeasible to assemble. However, these designs typically involve small sample sizes, outcomes measured in field settings, and data conditions marked by heteroskedasticity, non-normality, and outliers both unplanned and associated with the frequent use of ordinal scales to collect data. To address these issues, a Monte Carlo simulation study was conducted to evaluate the characteristics of four one-sided paired tests used in within-group analyses as to recommend the best baseline test for home healthcare researchers: the paired samples t test, the Wilcoxon signed-rank (WSR) test, and two Bayesian paired-samples t tests with default priors (Cauchy, Normal). The simulated data were designed specifically to reflect conditions commonly encountered in home health research, including small sample sizes (N = 10-50), heavy-tailed distributions, contamination by 5% extreme posttest outliers, and heteroskedasticity introduced by doubling posttest variance relative to pretest. Type I error rates were calibrated to 5% across all methods to ensure fair comparison. Results indicated that the WSR provided the most consistent performance across both normal and non-normal data environments, maintaining 5% Type I error and achieving higher average power under the heavy-tailed, contaminated, and heteroskedastic conditions most representative of home healthcare outcomes. Bayesian procedures outperformed the paired samples t-test in many conditions, but neither consistently exceeded the WSR. The paired samples t-test remained competitive only under clean normal, homoskedastic data with very small effects. Overall, findings support the WSR as the safest default test for small-sample within-group home health studies.
The International Home Care Nurses Organization (IHCNO) emerged in response to a recognized need for a dedicated international professional organization focused on nursing care in the home and community. This historical narrative review examines the organization's development from its early origins in 2008 through 2026. It analyzes how a volunteer-led specialty network contributed to the global advancement of home healthcare nursing. Archival records, peer-reviewed publications, conference materials, organizational documents, and oral-history feedback from founding and current leaders were reviewed and synthesized. Findings highlight IHCNO's progression from a journal-anchored grassroots initiative into an incorporated international professional association with five global conferences, international guidelines and standards, a research grant program, and strategic partnerships supporting education, research, and professional recognition. The organization's history illustrates how distributed volunteer leadership, strategic publication partnerships, and deliberate infrastructure development can strengthen specialty identity and foster international collaboration. As care increasingly shifts into homes and communities worldwide, IHCNO offers an example of how nursing organizations can support practice, research, and policy in evolving models of home-based care.
Home care nurses occupy a unique position in the health care system, observing patients in their living environments and coordinating care across multiple delivery sites. Social determinants of health (SDoH), encompassing economic stability, education, health care access, neighborhood conditions, and social context, account for an estimated 30% to 90% of health outcomes, far exceeding the contribution of medical care alone. This article examines the historical, organizational, and clinical foundations of SDoH within the context of home care nursing, underscoring the critical need for systematic assessment in patient care to ensure positive health outcomes. Drawing on the upstream, midstream, and downstream framework, this article describes how home care nurses can intervene at multiple levels: advocating for systemic change, connecting patients to community resources, and managing individual clinical and behavioral needs. The article also examines evolving policy and documentation requirements, including mandatory SDoH screening and the underutilized ICD-10-CM Z-codes, while highlighting gaps in social work utilization. The article further explores emerging models such as social prescribing as promising multilevel approaches to meeting patients' social needs. Ultimately, addressing SDoH is both a professional and ethical obligation for nurses, one that demands interdisciplinary collaboration and sustained commitment across all levels of care.
Optimal cardiovascular health during pregnancy and postpartum is critical for reducing maternal morbidity and mortality. Although lifestyle interventions effectively promote cardiovascular health, strategies are needed to reach the maternal populations with the highest prevalence of cardiovascular disease risk factors. Evidence-based home visiting programs, though not initially developed to address cardiovascular health, offer a promising platform for reaching pregnant and postpartum women at high risk for later cardiovascular disease. This study explored home visitor perspectives on integrating cardiovascular health content into home visitation. Guided by the Social Ecological Model, semi-structured interviews ( n = 10) and focus groups ( n = 8) were conducted with home visitors, supervisors, and program managers ( N = 33) from agencies in California and Rhode Island. Thematic analysis identified broad support for including heart health content, with participants emphasizing the value of culturally relevant, engaging, and flexible curricula that could be tailored to family needs. Organizational challenges included staff burden, training gaps, and funding for intervention sustainability. At the community level, strong relationships with healthcare providers and aligned messaging across systems were identified as key facilitators. Findings provide practical insights for the design and implementation of cardiovascular health interventions within home visiting and highlight the importance of addressing multi-level factors to support successful integration.
