5 Persistent Problems for Home-Based Care Programs

In-home care is frequently touted as a way to improve care, reduce hospital readmissions and cut national health care spending. But there are a number of roadblocks to implementing home-based health programs at scale and replacing institutional settings entirely.

One barrier, for example, that arises when an organization attempts to move care into the home is patients’ preference, according to a recent report from The Harvard Business Review (HBR).

Despite the general preference to age in place, the majority of older adults — 54% — often prefer that their treatment for acute illness takes place at a hospital instead of their home.


Why? In some cases, having treatment take place in the home can feel like an invasion of privacy or be a constant reminder of patients’ conditions, according to HBR. Additionally, some patients may not be aware of how recent medical advancements have complex at-home care possible.

Past negative experiences with caregivers and the desire to interact with others are also barriers when it comes to care preferences outside of the home.

Clinician concerns also factor into the equation and can prove problematic when seeking to move care into the home. For instance, home visits typically take longer than those in the hospital, meaning clinicians possibly seeing fewer patients in the course of their day.


Another challenge: Home-based care programs routinely focus and are structured around addressing social determinants of health, a strategy that isn’t widely rewarded under traditional fee-for-service models.

“Physicians spend more time understanding and addressing the social and economic conditions that impact health — such as remedying medication discrepancies, identifying home safety issues, and connecting patients with social services — but are disadvantaged under traditional fee-for-service models that tie payment to number of patients seen and procedures performed,” HBR authors wrote in their report.

That is starting to change, however, especially in the Medicare Advantage realm.

Meanwhile, some clinicians may also have concerns for their safety when paying a visit to a home in areas with high crime rates or other negative perceptions. That idea, in turn, could potentially lead to fewer home-based care programs in underserved areas of the U.S.

A lack of supporting infrastructure, including the proper assistive durable medical equipment, is also often a roadblock.

So too are inherent patient-safety risks found in the home, including environmental hazards like loose rugs or a lack of grab bars.

Overall, though, one of the biggest barriers remains the current regulatory environment, according to the HBR authors.

“There are no national or state requirements for the quality of home-based care, with the exception of care provided under the Medicare home health benefit, and limited regulation of the education, training, and licensure of home-based care professionals further endangers patient safety,” they noted.

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