Is There a Home Care Nursing Shortage?

By 2035, more than 78 million Americans will be over the age of 65, according to the Social Security Administration. Born after World War II, this so-called Baby Boom generation will soon need more nursing care than the system can provide. Healthcare has changed drastically in the last two decades, and as nurses take on more responsible roles, they’re in higher demand. Today, settings from schools and hospitals to rehabilitation facilities and public health departments all need more nurses, but nowhere is the shortage more evident than in home care.

Why is There a Nursing Shortage?

Birthrates in American rose steeply between 1946 and 1964. World War II was over, the economy was booming, and couples finally felt secure starting families. Now, the children of this generation are getting ready to retire, and for healthcare, that’s a double-edged sword.

Not only is the medical system experiencing an influx of new consumers, but among those retiring are nurses, many in the current nursing labor pool may be lost to attrition in the next five years. It’s a perfect storm for a shortage.

Why is the Shortage Affecting Home Care?

While nearly all sectors of the healthcare industry are growing, the benefits of home health are making it a leading specialty. The Baby Boomers would rather receive care at home, and services provided outside of institutions are proving to be far more cost-effective. It’s a win-win.

But home care is one area of nursing that traditionally suffers more than most because it’s unique. It’s rare for new graduates to get jobs in homes until they’ve had experience in acute care settings, but once they’ve been in one place long enough to learn the ropes, they’re incentivized to stay, and that means fewer nurses are available.

Thankfully, today’s nursing programs are recognizing the shift in demand toward home services, and they’re tailoring their curriculum to match. It’s the perfect time to get into home care.

What Do Home Care Nurses Do?

Home care nurses simply provide medical care to patients in their residences, either limited or long-term. Some home care nurses, for example, visit patients after they’ve had surgery to ensure they’re healing well and get follow-up care. Others manage patients with chronic disease who might otherwise need a nursing home. Their responsibilities include health assessments, medical management, personal care, and psychosocial support.

Health Assessments

Home care nurses are a doctor’s eyes and ears. They take vital signs, perform physical assessments, and report changes in condition to the physician. They then work with the patient and family to coordinate efforts and implement the plan of care.

Medical Management

Patients receiving home care are considered medically stable, but they need many of the same treatments as those in hospitals and nursing facilities including:

  • Wound care
  • Pain management
  • Therapeutic exercise
  • Chronic disease education
  • Medication administration include IVs and tube feedings
  • Nutrition counseling
  • Medical equipment management
  • Safety monitoring

Nurses work independently, but they’re also as part of a team that may include physicians, therapists, social workers, dietitians, and home care aides. In fact, they often serve as the gateway for involvement by other medical professionals when they follow up on a patient’s needs.

Because more than 133 million Americans now have chronic diseases such as diabetes and heart disease, according to the National Health Council, long-term medical management at home is a growing necessity. Nurses have the perfect skill set for helping stable patients with the day-to-day tasks that keep them healthy, such as monitoring their blood sugar and taking their medications properly.

Personal Care

Studies show that patients readmitted to hospitals shortly after discharge share a common experience, they have difficulty taking care of themselves. Many are exhausted and in pain, and their health declines because they can’t keep up with daily tasks such as bathing, dressing, and cooking. Home care nursing addresses those issues.

Nurses directly assist in limited circumstances but will more often use their medical know-how to create and supervise a plan of care that family caregivers and paraprofessional staff, such as home care aides, can follow when helping patients with these tasks. It’s an integral part of recovery for patients recovering from a short-term illness. For seniors with long-term needs, it can be the difference between living at home or a nursing home.

Psychosocial Support

Good health depends on managing every factor that contributes to a patient’s well-being, whether it be physical, emotional, financial or social. For example, a senior who could otherwise live safely at home might have to go into a nursing facility if they can no longer cook or afford nutritious food. Home care nurses understand that, and they would work to find a permanent home-based solution such as transportation assistance or low-cost meal deliveries.

Similarly, for patients burdened with loneliness, they can provide immediate companionship and emotional support while searching for long-term solutions such as peer groups and social visit volunteers. Maternity home nurses play an essential role in monitoring for post-partum depression and at-risk infant care, while hospice home nurses provide emotional and spiritual support for patients and families. The ways in which home nursing can improve the overall quality of healthcare are virtually endless.

Benefits of Home Care Nursing

Home nursing benefits both patients and the healthcare system. How?

It’s Safer

Falls and injuries in the hospital are caused, in part, by having to navigate unfamiliar surroundings while ill. Anyone over the age of 55 is vulnerable to temporal confusion when they’re sick, so unless being away from home is necessary, patients are safe at home.

Medical facilities care for the sickest among us. Despite their best efforts, they’re home to some of the most virulent organisms on Earth — many of which are treatment-resistant. When stable patients are released to their homes within 72 hours, the rate of facility-acquired infections decreases significantly.

It Promotes Independence

The longer someone is confined to a hospital or nursing facility, the harder it is for them to maintain their independence. Someone, usually a family member or friend, takes over day-to-day activities such as paying bills, and it becomes harder for patients to remain involved.

When care is delivered where day-to-day activities occur, patients, especially seniors, are more likely to take an active role in decision-making.

It Enhances Healing

Research suggests patients heal better in their homes. Why? In addition to factors such as lowering the risk for infections, people report being more comfortable, so they’re able to sleep and eat better while benefiting from more frequent visits from family and friends.

It Costs Less

As seniors live longer, managing their money becomes increasingly more important. Home nursing care can cost much less than care provided in nursing facilities or assisted living centers. Patients can also save thousands every day they receive care at home instead of in the hospital.

It also reduces costly readmissions. Analyses show the risk of readmission is highest after discharge because patients are weak and may have unanswered questions. Return rates are consistently lower when home care nurses follow up in person within the first few days.

Skills for Home Care Nurses

There are many skills that a home care nurse must possess to be successful. They include communication skills, confidence, initiative, open-mindedness, critical thinking, and time management skills.

Communication Skills

Home care nurses are responsible for communicating with patients, families and associated physicians. It requires the ability to read, write and speak with authority as well as proficiency with electronic communication.


Nurses working in facilities have immediate back up when they need it. In a private home, support is available by phone, but it takes longer, and it’s not hands-on. Nurses need to be professionally competent in any setting but working in private homes requires they be relaxed and confident about their abilities.


Home care nurses are like case managers. They’re responsible not only for their patient’s physical health but also for managing other factors that affect their well-being. From housing and financial needs to nutrition and transportation, home care nurses have to look at the big picture and initiate interventions when necessary.


Patients come from all walks of life. They have different worldviews and beliefs about healthcare that may not always align with their doctor’s recommendations.

Within the walls of an institution, policies and procedures help insulate nurses from making value judgments to a certain degree, but in private homes, patients want care that’s more closely aligned with their beliefs. Home care nurses are called to be open-minded.

Critical Thinking

Critical thinking is the ability to look at data objectively and make sound, evidence-based decisions. It’s what tells a home care nurse that a patient’s lack of transportation is more than an inconvenience, it can affect their ability to do even the most basic activities such as shopping for food.

Home care nurses have a broad scope of practice and are involved in many aspects of patients’ lives. Critical thinking skills allow them to assess complicated situations and make the logical connections necessary to solve problems.

Time Management Skills

Working in private homes can seem relaxing compared to racing around a busy orthopedic unit, but it’s just an illusion. Hospital patients are all in one place. Home care nurses need to plan visits around the patients’ schedules and allow for both travel and follow-up time. Time management skills are a must.

Final Thoughts

Home care is rewarding because it supports patients where they want to be. But as a career path, it’s also the fastest-growing sector of the healthcare industry and is projected to add up to third of a million jobs by 2028, according to the U.S. Bureau of Labor Statistics. It’s a great time for students interested in nursing to get involved.

Did learning about the shortage in home care nursing interest you? The Associate of Science in Nursing degree program at Gwinnett College provides training to prepare college graduates to enter the nursing profession as a registered nurse.  Classroom theory, challenging assignments, skill labs, simulations, and clinical experiences help to prepare college graduates for an entry-level nursing position. 

Upon successful completion of the program and demonstrated nursing competence, the college graduates will be eligible to apply to take the NCLEX-RN licensure examination.*   Upon graduation and licensure, college graduates will be eligible to seek employment in hospitals, clinics, private duty, urgent and acute care centers, and various other medical or business facilities requiring the services of registered nurses.

*While Gwinnett Institute provides test preparation and review assistance to college students, it cannot guarantee any college student will be able to take or pass any type of licensure exam.  College students must be mindful throughout their entire training program that licensure is a pre-requisite for employment as a nurse and to diligently prepare themselves to meet this important requirement.

Contact us today to learn more about becoming an RN at Gwinnett College.