Duke University launched a four-year program this spring with a $3.9 million federal training grant aimed at helping better prepare nurses for a growing trend in healthcare: treating patients where they live.
“In the hospital, nurses really have all the power and the patients are literally stripped of their clothing,” said Donna Biederman, associate clinical professor at Duke University School of Nursing. “In the community, the nurse really needs to understand the dynamics. It can be very humbling when you are in a place where you’re not necessarily able to call all of the shots.”
Patient preference, technology and new health insurance payment models, such as value-based care, are driving healthcare into the home.Within two years, $265 billion in healthcare services are expected to shift from traditional healthcare facilities to the home, a threefold increase from today, according to consultancy McKinsey & Company. Medicare will account for a quarter of the spending as 72 million baby boomers age into the federal health insurance program.
Increased demand for home-based medical care comes at the same time demand for nurses is booming. The Labor Department projects the U.S. will need an additional 200,000 nurses by the end of the decade. The statistics are sparking collaborations between schools and home health providers to attract more students to nursing, train them to work in patients' homes and provide them with jobs after graduation.
For nurses new to the profession, working in the home can be challenging. They work by themselves and often travel several miles a day, especially if they serve rural areas. But home-based care also has benefits: Home health nurses often have more flexible schedules and build stronger relationships with patients. Home health firms are capitalizing on those benefits to forge new partnerships with nursing schools.
Two years ago, home health firm LHC Group invested $20 million in the University of Louisiana at Lafayette’s Myers School of Nursing to provide scholarships to student nurses and to also help recruit nurses after they graduate. UnitedHealth Group, which acquired LHC Group in March, said it will continue the partnership with the college.
Humana-owned CenterWell Home Health, which operates 350 locations nationwide with 10,000 nurses, has partnerships with approximately 50 nursing schools. CenterWell lets student nurses do rotations at its home health agencies and also sends guest lecturers to the schools to speak to students about care in the home. Humana said it initiated the relationships with schools it thought would be a good match with the company and as a way to recruit nurses.
Last summer, the Louisville, Kentucky-based company took on an even bigger role in training nurses when it donated $170,000 to create the CenterWell Home Health Lab at the new Emory Nursing Learning Center at Emory University’s Nell Hodgson Woodruff School of Nursing. The lab in Decatur, Georgia, is set up as a studio apartment to better simulate how care is performed in a home setting.
Beth Ann Swan, the nursing school’s interim assistant dean, said the lab teaches students how to interact with patients in their homes, use home-based medical technology such as remote patient monitoring, and make assessments on whether a home environment is safe for the patient.
Since most of CenterWell’s collaborations started during the COVID-19 pandemic, they are only starting to bear fruit. Kathy Driscoll, Humana’s chief nursing officer, said the partnerships have helped the company recruit only a few nurses into home care. However, Driscoll said the company was confident the partnerships will help build a pipeline to potential hires in the future.
Other nursing schools are considering adding in-home training, including St. Francis Medical Center College of Nursing in Peoria, Illinois, and OSF St. Anthony College of Nursing in Rockford, Illinois, both owned by Catholic nonprofit OSF Healthcare.
Last summer, OSF HealthCare launched a hospital-at-home program called Digital Hospital in Peoria, Illinois, and plans to launch a similar program in Rockford, Illinois, later this year. Digital Hospital is an alternative to traditional hospital care that allows patients with certain conditions, such as congestive heart failure, pneumonia or COVID-19, to receive care in their homes.
Megan Malaran, one of Digital Hospital’s 15 registered nurses in Peoria, thinks student nurses would benefit from training in hospital-at-home. She said despite eight years of experience as a nurse, she found she needed different skills to care for patients in their homes.
“You have to rely on your eyesight and your critical thinking skills when you are in the patient’s home,” Malaran explained. “You have to think outside the box in terms of body mechanics. Should I start an IV with the patient in a chair or move over to a table?”
Home health firms are becoming more proactive in reaching out to nursing schools about opportunities in healthcare. Emory University said more companies are offering nurse residency programs to help nurses transition directly from college to jobs in home care and are offering home-based immersion programs as part of their training.
