Receiving health care in the home is preferred by most people. However, providing care in the home is not without its challenges. There are a variety of needs for each population being served – this may include issues with communication and care coordination.

For many, care in the home includes not only engaging with a clinical team but also receiving care from a larger team which may include a family caregiver, home health aide and personal care assistant. The Institute for Healthcare Improvement has been studying how to prepare for and address these challenges and ensure the safety of those receiving care at home.

With foundation support, the Institute for Healthcare Improvement (IHI) gathered specialists and experts in community-based care and safety to identify strategies for improving patient safety in the home. Knowing this topic hasn’t received as much attention as patient safety in hospitals and other clinical settings, participants were tasked with considering the challenges to safety in the home and providing recommendations, strategies and tools for ensuring the physical and emotional safety of patients and those caring for them.

The IHI work is the second piece of a larger effort supported by the foundation’s Patient Care Program. The first part of the effort included funding for the Institute for Healthcare Improvement, in collaboration with Westat, to conduct an assessment identifying the challenges and gaps in understanding issues of patient safety in the home.

Building on the assessment and the expert panel meeting, IHI released “No Place Like Home: Advancing the Safety of Care in the Home.” The report considers the physical and emotional safety of the care recipient, the family caregiver, and the home care worker, while recognizing the interconnected nature of the safety of all these individuals. The panel identified five guiding principles that are foundational to improving safety in the home:   

Principle 1: Self-determination and person-centered care are fundamental to all aspects of care in the home setting.

Principle 2: Every organization providing care in the home must create and maintain a safety culture.

Principle 3: A robust learning and improvement system is necessary to achieve and sustain gains in safety.

Principle 4: Effective team-based care and care coordination are critical to safety in the home setting.

Principle 5: Policies and funding models must incentivize the provision of high-quality, coordinated care in the home and avoid perpetuating care fragmentation related to payment.

Underpinning these principles is a conviction that safety in the home deserves the same level of attention that has been given to safety in other settings. Through our work, we hope to improve the experience and outcomes for patients receiving care in their homes. With our serious illness care work, this means ensuring high-need patients are receiving high-quality, community-based care that is safe for them as well as their caregivers.



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