Health Care Services at Home Outpacing Attention to Safety

New IHI report offers recommendations for improving the safety of care provided in the home

BOSTON--()--Millions of people are recovering from acute illness or coping with chronic conditions in their own homes, but their care may not always be delivered under the safest of conditions. In a new report, the Institute for Healthcare Improvement (IHI), a leader in health and health care improvement worldwide, finds there are numerous risks to care recipients and caregivers alike due to the growing complexity of health issues now dealt with at home and the lack of training and preparation to manage it.

No Place Like Home: Advancing the Safety of Care in the Home, the work of a panel of subject matter experts convened by IHI, focuses on recommendations to drive improvement. It follows an earlier environmental scan of the shift of health care to the home and the accompanying risks. Both reports were funded by the Gordon and Betty Moore Foundation.

Care in the home is increasing thanks in part to rising health care costs, an aging population, patient preference, and advances in technology that allow for even some complex care to be administered locally. Care recipients benefit by having greater autonomy than they would in a health setting, maintaining family and social ties, and reducing their risk of certain complications (such as sleep disruption). Home care can also help lower costs of care and allow health professionals to assess related concerns, such as nutrition.

No Place Like Home holds that in order to achieve these benefits, we must be cognizant of risks of harm in the home setting as well, such as injuries due to physical hazards or medical equipment, pressure injuries, infections, poor nutrition, adverse events related to medication or other treatment, and potential abuse or neglect. Moreover, health care workers and family caregivers are themselves at risk of physical and emotional harm and burnout.

Fortunately, to move on the findings, stakeholders don’t need to start from scratch. “Home health care organizations as well as hospice and palliative care providers have started to lay a foundation for promoting safety in home care,” said Tejal K. Gandhi, MD, MPH, CPPS, Chief Clinical and Safety Officer, IHI. “For example, hospice and palliative care programs effectively coordinate care provided by multiple caregivers, such as nurses, social workers, bereavement counselors, and spiritual care. That kind of coordination is largely lacking when it comes to other kinds of care in the home. As the numbers of people receiving care at home continue to increase, we hope this report will serve as a useful reference for those committed to building on that foundation.”

The report details five Guiding Principles for advancing safety in the home:

  1. Self-determination and person-centered care are fundamental to all aspects of care in the home setting.
  2. Every organization providing care in the home must create and maintain a safety culture.
  3. A robust learning and improvement system is necessary to achieve and sustain gains in safety.
  4. Effective team-based care and care coordination are critical to safety in the home setting.
  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.

“While there is much safety knowledge to draw upon after decades of work in hospitals and other health settings, the challenges to keeping care recipients and their caregivers safe in the home are vastly different than they are in those controlled environments,” said Diane Schweitzer, Acting Chief Program Officer of the Gordon and Betty Moore Foundation’s Patient Care Program. “The guidelines offered in this report are meant to promote safe, person-centered care in the home.”

The report includes case studies of eight programs across the country that are showing results in reducing costs, improving safety, and providing more comprehensive care than is currently the norm.

The recommendations will be discussed during a session at the IHI National Forum on Quality Improvement in Health Care, December 9–12, in Orlando, Florida. To request press credentials for the event, email

The new report can be downloaded at

For more information about this work and other patient safety programs at IHI, visit

About Us

The Institute for Healthcare Improvement (IHI) and the National Patient Safety Foundation (NPSF) began working together as one organization in May 2017. The newly formed entity is committed to using its combined knowledge and resources to focus and energize the patient safety agenda in order to build systems of safety across the continuum of care. To learn more about our trainings, resources, and practical applications, visit


CXO Communication
Joanna Clark, 207-712-1404

Release Summary

IHI issues new report on safety in the home, a growing site of health care for those recovering from acute illness or managing chronic conditions.


CXO Communication
Joanna Clark, 207-712-1404