Report Calls for Improvement in Home Health Care

July 18, 2011 -- Home health care is a growing trend, allowing many people in need of medical services to avoid hospitalization and nursing homes. But improvements are needed to be sure that care at home is safe and effective, according to a new report from the National Research Council.

"There is a great opportunity to provide quality health care in the home for any of a variety of people in our population, from the very young to the very old," says David H. Wegman, MD, emeritus professor of work environment at the University of Massachusetts, Lowell. He chaired the National Research Council committee which issued the report.

"But to do this safely and effectively, we need better management and information about technologies as they are used in the home, and better training for both formal health care providers and the large informal pool for how to use these technologies in the home safely and effectively," Wegman tells WebMD.

Wegman says he is talking about medical devices from as seemingly simple as a home blood pressure monitor to more complicated oxygen delivery systems and other devices.

The report, "Health Care Comes Home: The Human Factors," was released today.

One in four U.S. adults, or more than 61 million Americans, cared for an adult family member, partner, or friend with a medical condition or disability in 2009, according to another report, also issued today, by AARP. It put the value of all this care at $450 billion in 2009. That is up 21% from the total in 2007. The AARP report is titled "Valuing the Invaluable: The Growing Contributions and Costs of Family Care giving, 2011 Update."

Recommendations for Home Health Care

The National Research Council report was requested by the Agency for Healthcare Research and Quality. The National Research Council is the principal operating agency of the National Academy of Sciences and National Academy of Engineering.

The National Research Council committee sought out experts. It also conducted a workshop on human factors in home health care before issuing the report.

Among the recommendations:

• The FDA should promote the development of new standards for labels on medical devices for home use. They should set new standards for the instructions that accompany the devices. The instructions should be easily understood.
• The FDA and the Office of the National Coordinator for Health Information Technology should work together to regulate, certify, and monitor devices and health information technologies. For instance, they should work together on a device such as a blood pressure monitor and the technology that relays the results to doctors and patients.
• The FDA should improve its existing reporting system for medical device problems. The system is known as MAUDE (manufacturer and user facility device experience). Wegman cites problems, including being poorly used.
• Training of home caregivers, both formal and informal, should be improved. Advocacy groups and professional practice organizations should take on this task, the committee says.
• Research is needed in many areas, including how to better coordinate caregivers and support services.
• Federal agencies such as the Department of Health and Human Services should help people who need home health care to modify their homes for caregiving when needed.

Wegman says the hope is that the FDA and others involved will read the recommendations and begin to implement them.

AARP Perspective

The recommendations are applauded by AARP, says Susan Reinhard, PhD, RN, AARP's senior vice president of public policy. She wrote the AARP report.

"We call it the new normal, this caregiving," she tells WebMD. And it is not simple.

In its report, AARP finds that home caregivers are asked to do more complicated services. This includes bandaging and wound care, tube feedings, managing catheters, and giving injections and operating medical devices.

"Some of the things that family caregivers do would make a first-year nursing student shudder," Reinhard says in a news release.

In an interview with WebMD, she says that the National Research Council report "supports our overall goal of helping people to live at home independently if that is their choice."