Pediatric Home Care: Challenges and Solutions

A new Health Affairs report examines some major financial and practical challenges in the delivery of pediatric home health, resulting in unnecessary hospital lengths of stay for children and other systemic shortcomings that mirror experiences in New York State.

According to the article, only 2% of Medicaid spending for children with medical complexity has gone to home health care. This has driven a disparity in wages that disincentives home care for kids: median hourly wages for pediatric home health care services in 2017 were $33.77, compared to an average of $36.45 for in-patient care, according to the report.

When it comes to delivering care in the least restrictive setting, the stakes are no greater than for kids who need the care, trust, and nurturing of their families while coping with a debilitating illness or disability.

Some New York providers are exploring ways of developing pediatric home care programs. Others have long served thousands of children and families. They’re innovating with new tools like home telehealth to expand opportunities for children to get care and monitoring at home.

Here are some specific challenges, and solutions, for pediatric home care in New York State that the Legislature should consider.

Reimbursement rates in urgent need of adjustment

Currently, the reimbursement rates for pediatric nursing and private-duty nursing for pediatric cases are so far below market levels of compensation that agencies cannot recruit and sustain a sufficient number of nurses for these cases. As a result, children in hospitals and in specialty pediatric facilities are held in these facilities longer than necessary, creating hardship for their families and unnecessary costs. HCA has recommended and offered to craft legislation creating demonstration rates to address this issue. We believe these demonstration rates would enable effective recruitment and retention of pediatric nurses, with the opportunity to prove that this is so by comparing outcomes with non-demonstration control groups to determine the impact on hospital lengths of stay and other factors.

Care of children while in school

Children requiring daily nursing care experience interruption in vital access to their regular nurses when schools insist on using their own nurses or school-contracted nurses, instead of allowing the child’s regular nurse to provide the care. For kids on ventilators or with other intensive needs, this interruption unnecessarily imposes on the close familiarity and personal, trusted relationship that a child maintains with his or her regular nurse and it infringes on a family’s sense of security in knowing that their child is in familiar hands. More can be done to foster state protocols that ensure continuity-of-care in schools.

Alignment of program requirements to pediatrics

Much of the long-term care system is oriented around the needs of older adults and adults with disabilities. Pediatric home care providers and, most importantly, patients would greatly benefit from the tailoring of state program requirements, forms and regulations, wherever possible, to pediatric care. This includes a more customized consideration of the family and the family’s needs. HCA advocates for the formation of a special state workgroup to examine and make recommendations for tailoring procedures and requirements that would better align with pediatric home care services.