1. Piskor, Barbara MPH, BSN, RN, NEA-BC

Article Content

I didn't notice many young faces at a recent home care conference. Attendees, myself included, had a lot of wrinkles and gray hair. I admit, some of the gray hair might have been COVID-19 initiated, but the fact remains that we need a younger generation to carve out the future for in-home care services and for home care nursing leadership. The need has never been greater. Wearing my very dated nursing cap, I recognize what an exciting time it is for in-home healthcare services. We are, at long last, in the spotlight. The pandemic brought an increased preference for in-home care and an AARP (2021) survey found 77% of respondents want to remain in their homes for the long-term, once again highlighting the desire of many to age in place.


Several hospital-based healthcare systems have developed plans for downsizing. A number of hospitals are scaling back or ending inpatient care. For example, an article in Becker's Hospital Review (2022) revealed nine hospitals closing or reducing traditional med-surg beds and developing in place, intensive care units and/or ambulatory care settings. We now know acute, high-tech care can be safely provided in the home. The Hospital at Home model, recognized recently, by the Centers for Medicare and Medicaid Services for reimbursement, assists with bringing attention to home care. The Aging in Place model also reinforces the role of nurses who are experienced in home care to train and supervise aide-level workers for long-term care in the home. To achieve success, we need nursing leadership to address current care needs and anticipate future care planning, service, and educational needs. These activities highlight the important role of home care nurses in quality of life, care delivery and value-based, cost-effective healthcare delivery systems. A study by Howard et al. (2019) confirmed that patients with serious, long-term illnesses who were treated in a home-based setting were significantly less likely to be admitted or readmitted to the hospital and had fewer visits to the emergency room.


Educational preparation of nurses brings leadership challenges. The trend for home health agencies to provide only observation-based experiences for student nurses has decreased the number of graduates (and potential leaders) interested in, or prepared for, home healthcare. Nursing students now receive population health experiences, which provide an excellent public health base, but do not prepare the student for home healthcare. We need educators and current agency leaders to address this critical need.


A 2020 Home Healthcare Now Commentary article described the impact of supervisors in influencing job satisfaction and retention, and the role of professional organizations in offering leadership development courses (Bryant & Magan, 2020). Identifying, recognizing, and encouraging future home care nurse leaders is so important to the future of home healthcare nursing. We also need to support and encourage potential future leaders toward advanced education necessary for positions as directors and chief operating officers. To develop the next generation of home care nursing leaders, we need to consider industry and agency practices, supervisory/leadership development support, professional organization priorities, and educational preparation. Let's develop an action plan and implement it.




AARP. (2021). Despite pandemic, percentage of older adults who want to age in place stays steady.[Context Link]


Becker's Hospital Review. (2022). Nine hospitals cutting inpatient care.[Context Link]


Bryant N., Magan G. (2020). Nurse leadership in home healthcare. Home Healthcare Now, 38(5), 287. [Context Link]


Howard J., Kent T., Stuck A., Crowley C., Zeng F. E. N. G. (2019). Improved cost and utilization among Medicare beneficiaries dispositioned from the ED to receive home health care compared with inpatient hospitalization. The American Journal of Accountable Care, 7(1), 10-16. [Context Link]