Home-Based Pediatric Care A Leap For Patients, A Struggle For Providers

In January, I wrote a story on pediatric private-duty nurses that has become one of our most-read articles so far in 2025 and elicited reader engagement. One reader wrote to me expressing support for companies offering this type of care.

“As the mom of a medically complex child, a big challenge we’ve encountered is how we can overcome the hurdle of the continuum of care with nursing at school and at home. It’s an extremely daunting process. It’s great that some have taken critical steps to make it as easy as possible for families to navigate.”

While strides have been made, the need continues to grow, and providers are making moves to expand in this market.

The number of children suffering from chronic illnesses such as asthma and diabetes has been steadily increasing, according to the Healthy Children Organization, which has led to a greater demand for home health care services. From $12.53 billion in 2023, the pediatric home health market is expected to grow at a compound annual growth rate of 7.85% through 2030, according to Grand View Research.

“The pediatric home care space really is not that old,” Mark Kulik, senior managing director of home health, home care and hospice for M&A advisory firm The Braff Group, told me during a conversation last summer. “About 25 to 30 years ago or so is when the concept of taking a medically fragile child home and out of the hospital really began.”

Kulik noted that insurance companies and states preferred pediatric home care primarily for cost reasons, as most of these services are funded by Medicaid.

“The combination of technology, confidence in specific skill sets and the personal desire to have children at home was the initial driving force,” he explained. “As this model demonstrated success, more hospitals began adopting it as standard practice.”

Now, hospitals continue to be at the forefront of pushing toward more advanced pediatric home health. Earlier this year, health system Atrium launched the nation’s first pediatric hospital-at-home program.

However, at-home care providers interested in expanding into the pediatric market must contend with some serious challenges. These include identifying the right operating models and payment structures, hiring suitable caregivers and addressing the emotional and physical burnout of job demands.

In this week’s exclusive HHCN+ Update for members only, I provide an analysis and key takeaways, including:

• The advancements in this type of care

• Strategies for hiring and training the right caregivers

• How an unfolding situation in Maine illustrates reimbursement challenges

Making a difference for medically complex children

Despite being a relatively new service, as Kulik noted, pediatric home health has gained sophistication, with models that can serve patients with various conditions. And with a greater ability to deliver at-home care for pediatric patients, companies that serve this population have expanded and attracted investment.

Pediatric home health care providers offer various services to assist children with medical needs, including grooming, wound care, mobility assistance, medication administration, enteral tube feeding, suctioning, ventilators and other support.

This type of care strongly emphasizes the family unit and recognizes the vital role that parents and caregivers play in the child’s well-being. Health care professionals work closely with everyone in the household to ensure that the child’s medical needs are met safely and effectively, according to Baltimore’s Johns Hopkins Medicine. Collaboration and open communication are essential for delivering comprehensive and personalized care, like caring for adults in the home.

A well-coordinated pediatric home health service is typically led by a pediatrician who ensures that the home environment resembles a hospital setting and provides comprehensive pediatric health care services.

Home health care staff monitor and provide medical services. Additional health care professionals may include speech-language pathologists, occupational and physical therapists, social workers, licensed practical or vocational nurses, nutritionists, and personal care aides.

Demonstrating the advancements in how complex care can be delivered in the home for pediatric patients, Charlotte, North Carolina-based Atrium Health has reportedly seen early success with the nation’s first pediatric hospital-at-home program. The organization has been offering hospital-at-home services for adults since 2020.

Atrium, part of North Carolina-based Advocate Health, launched the program at Levine Children’s Hospital in February and has, according to the organization, provided acute-level care at home to about 20 children.

Levine’s pediatric hospital-at-home program cares for North Carolina patients younger than 18 who live within 30 minutes of the hospital, qualify for hospitalization, but can receive care in their homes. Board-certified providers trained in pediatric hospital medicine care for patients, including daily in-person paramedic visits, telehealth visits with physicians and remote monitoring.

Atrium said the program’s primary goal is to reduce patient readmissions at Levine’s Children’s Hospital, which could encourage other children’s hospitals to launch similar programs. The organization also hopes to expand the program to patients in every region it serves.

Kulik and First Day Homecare Founder and CEO Emily Wiechmann told me last year that technology has been a driving force behind the advancements in pediatric home health.

​​“As recently as 20 years ago, a child born with a serious condition like Spinal Muscular Atrophy (SMA) Type 1 did not have the option to remain in their home as their condition progressed. Home ventilators have evolved such that these children can safely be cared for in their homes and survive much longer now,” Wiechmann said.

Kulik noted that dramatic advancements in remote monitoring technology have also been a particular boon to the growth of at-home pediatric care.

Just as the ability to deliver pediatric home health has advanced, so too has the amount of capital flowing into this part of the market. Between 2019 and late summer of 2024, 29 pediatric home health companies were acquired, Kulik told me. One example is Nautic Partners’ February 2024 acquisition of Angels of Care. Florida-based pediatric home health provider KidsSpot grew through acquisition to have 14 brands as of 2024, at which point the company combined them into a single care hub and clinical provider branded as MySpot.

In 2023, First Day became the first company specializing in pediatric home health to launch a franchise model, which Wiechmann believes will help accelerate these services’ growth by helping entrepreneurs overcome obstacles.

“There are things like accreditation requirements; higher licensing requirements in some of the states; Medicaid enrollment is an absolute must, which can sometimes get a little bit complicated,” she told HHCN in Aug. 2023. “The barrier to entry is a little bit greater, but the benefit is that once you get through that entry, and start providing the services, there’s a great volume of patients out there just waiting for your services.”

Hiring and training the right caregivers

While the desire for this type of home care is growing, the barriers to entry that Wiechmann referred to are indeed significant. They include mental, emotional and physical stressors and a lack of specialized training for caregivers. These challenges can be particularly acute when working with children; not every home health worker is prepared to handle this type of care.

Health care professionals providing this type of home care undergo specialized training in pediatrics to equip them with the knowledge and skills necessary to address the unique medical, developmental, and emotional needs of the children in their care.

From smaller-sized blood pressure cuffs to child-friendly monitoring devices, health care professionals must ensure that the equipment is appropriate for the child’s age and size. This attention to detail helps ensure accurate assessments and greater comfort for the child.

However, there often aren’t caregivers who can meet the growing demand. Wiechmann pointed out that inadequate training and skewed expectations are partly to blame.

“Training is critically important,” Wiechmann told me. “When you’re providing a service that nurses are not routinely trained on, such as caring for an infant on a ventilator, that’s a barrier.”

She explained that some nurses leave job opportunities because of fears and misconceptions about caring for children with medical complexities. To combat this, nurses need better training and support through clinical mentorship programs.

Workforce shortages in pediatric home health care stem partly from inadequate Medicaid payments and a lack of training and support for home-based care providers.

“Pediatric home health providers are vying and competing with other care settings like hospitals in recruiting,” Weichmann said. “It can be difficult to recruit a nurse from a setting where they make more money per hour than what can be paid in the home health setting. Bringing awareness to these pediatric home health services is a step in the right direction.”

She added that several states are taking positive steps by increasing their Medicaid reimbursement rates, enabling providers to be more competitive in recruitment. Despite this positive trend, reimbursement is another area rife with complexities for pediatric home health.

Reimbursement challenges

Prolonged hospital stays can be expensive, making pediatric home-based services a more cost-effective solution that enhances patient care efficiency. As a result, many home health providers are expanding their services to meet the increasing demand for pediatric care.

However, some providers, such as Andwell Health Partners in Lewiston, Maine, struggle to maintain their pediatric home care programs due to reimbursement issues.

Andwell provides therapy, nursing care, case management, hospice and other services to over 900 pediatric patients with complex needs. Unfortunately, in January of this year, the company had to discharge or transfer some children to outpatient care because MaineCare, Maine’s Medicaid program, has only increased reimbursement rates once in the past two decades. This has made it unsustainable for Andwell to continue caring for these children.

Over the last 10 years, Andwell has incurred millions of dollars in deficits due to inadequate reimbursements from MaineCare, according to the company. These reimbursements do not adequately cover salaries for the skilled professionals who care for children enrolled in the program.

“When 96% of our pediatric patients rely on MaineCare to fund their health care, and MaineCare home health rates haven’t seen meaningful increases in 20 years, it becomes impossible to make ends meet,” President and CEO Ken Albert said in a statement. “As a society, we pay for what we value, and I firmly believe that the people of Maine want to ensure all children receive the care they need for the best possible chance at a bright future – our future.”

The company has been urging Maine’s Department of Health and Human Services (DHHS) to adopt a plan to ensure that children who require skilled home health care receive the necessary services.

The organization presented DHHS with solutions to financially support home health visits for its patients and all children enrolled in MaineCare across the state.

Since increasing MaineCare reimbursements will take time, Andwell’s plan proposed redirecting funds from unused health care transportation resources to help supplement the home health MaineCare rate. Additionally, Andwell suggested an alternative payment structure for medically complex children. The proposed structure is based on a model that DHHS created for reimbursing care delivery and case management for similarly situated MaineCare enrollees.

Albert presented this plan to DHHS at a meeting in December 2024. DHHS has not responded nor provided a timeline for when one might occur. Likewise, DHHS did not respond when I reached out for comment.

“Every day that passes leaves children with medically complex issues and the livelihoods of their caregivers more at risk,” Albert stated.

The Maine DHHS and Child Welfare Action Network (MCWAN) did release the Child Safety and Family Well-Being Plan in February. The comprehensive five-year plan aims to promote the safety and well-being of children in the state by strengthening support for families.

The plan builds on Governor Janet Mills’s 2023 framework. Further, it aligns state agencies, community partners, and individuals around the idea that keeping children safe begins with keeping families strong.

“This plan establishes a shared commitment to ensuring children and their families can get the help they need, when they need it,” Melissa Hackett, MCWAN coordinator, said in a press release. “It is important that this plan is not just about policies – it is about people. It was shaped by the voices of families and communities, and we invite all Mainers to play a role in making it a success.”

The plan encompasses two main objectives and complementary strategies to proactively assist families and enhance the network of resources available statewide.

Goal one is to assist parents and caregivers in providing safety, health and nurturing care for their children. Although it doesn’t specifically mention MaineCare reimbursements, it highlights health and well-being provisions for children in the state, which appears to be a positive step forward.

Many more positive steps forward will be needed to support the expansion of pediatric home health, not just in Maine but across the country. And with the threat of Medicaid cuts looming at the federal level, reimbursement is poised to be the primary check on providers who want to expand in this part of the market. Still, as the recent investment and expansion activity in pediatric home health shows, determined providers will find ways to seize the opportunity presented by the significant demand for these services.