What to Know About the Growing Demand for Home Health Nurses

Treating sick and injured patients in their own homes was once the standard for healthcare delivery. Hospitals were a last resort for the critically ill or for people without family, friends, or neighbors who could help them at home. In much of the world, home healthcare is still common. In the United States, only a fraction of registered nurses work in it. That is starting to change, and the demand for home health nurses is climbing with it.

What sets home health nursing apart

Home health nursing is nursing care delivered in the patient's home. It takes many forms, and the day looks nothing like a traditional unit.

"It can be home visits from a home health agency after someone returns home from the hospital to recover from surgery or illness. It can be a hospital-based program where they'll do maybe a one-time visit to people who they worry about. It could be home dialysis from a dialysis center. Public health agencies and hospitals will sometimes do maternal child visits, and then hospices provide hospice care, so there's quite a bit of variety," said Dr. Susan Hinck, PhD, a gerontological clinical nurse specialist and president of the International Home Care Nurses Organization.

Home health nurses are usually assigned to the same patients and visit them on a regular basis, which builds continuity and closer relationships over time.

"I like the long-term relationships where you work with someone and see what's important to them, and you get to see how they're getting along with the interventions. What works, what doesn't work," Hinck said. "It's working with people in a way that's more holistic, more complete, because they're in their own setting. You can see how they're doing in their setting, and all those other things that you need to look at to make sure someone is safe and getting healthy."

The autonomy is the other thing that sets the work apart.

"Some of the things that are different about home-based care is the nurse has greater autonomy because they're alone in the home," Hinck said. "There's no next shift coming on. If you don't see it, nobody's going to see it. If you don't assess it, it's not going to get assessed, so you really have to be very skilled in doing a comprehensive patient assessment, and not just looking at the patient but their environment. Whether they have food, if they can prepare the food right, do they have transportation to a medical appointment, do they have the correct medication in the home and know how to take it. It's a lot of things to think about."

You also have to fold the patient into the plan of care far more than you would on a unit. "This is an especially important thing in home care: include the patient," Hinck said. "In the home, the patient has the ultimate authority over their own actions, what they're going to do, what they're not going to do. So if it isn't the patient's plan of care, it's just not going to go anywhere."

Why demand is rising

The numbers point the same direction. A 2023 Health Affairs report examined home and community-based services funded by Medicaid, the primary payer for long-term care. Between 2013 and 2020, the number of Medicaid HCBS participants grew faster than the workforce serving them. The number of home care workers per 100 participants fell 11.6% from 2013 to 2019, and early estimates show the trend continuing. That gap translates into job opportunities for home health nurses.

"There is a growing demand I think," Hinck said. "In the United States, about 12% of registered nurses work in home healthcare, and that's a pretty small percentage, but that's also an underestimate because it's nurses that only do home health and it doesn't look at all the other ways nurses go into homes."

The aging population is the main driver. According to a 2023 report from the Administration for Community Living, the population age 85 and older is projected to more than double, from 6.5 million in 2022 to 13.7 million in 2040. Home health services lean heavily toward older adults, so that growth feeds straight into demand for home health nurses.

The U.S. Bureau of Labor Statistics backs this up. The BLS projects employment of home health and personal care aides to grow 21% from 2023 to 2033, much faster than the average across all occupations. Registered nurses are a separate category, but the signal is the same: home-based care needs more professionals across the board.

Why you should consider the work

Beyond the job outlook, home health nursing offers a few things other settings can't.

Closer relationships with patients. Treating the same people over months lets you build bonds the in-and-out pace of other settings rarely allows. "It is a way to blossom as a nurse because you are one-on-one. You can give that patient all of your attention, and that's very gratifying," Hinck said.

Flexible scheduling. Home health nurses tend to have more control over their schedules. On holidays, for example, patients enjoying time with family may not want a visit, so you may not have to work those days either.

Working alongside other disciplines. In home-based care you collaborate more directly with occupational and physical therapists. On a unit those disciplines run somewhat separately. At home you have to confer to stay aligned on what each provider has done and how the patient is progressing.

More daily autonomy. Out visiting patients, you are usually on your own. You still report to a clinical supervisor, but you carry more decision-making authority than nurses in most other settings.

How the pandemic reshaped it

You can't look at home health nursing today without accounting for COVID-19.

"COVID impacted absolutely everything in healthcare, in all settings. What we saw at the time was many patients who needed help at home declined home visits for illness or after hospitalization because they were afraid to have somebody come into their home and bring an illness in. But on the other hand, that's when the Hospital-at-Home program started," Hinck said.

The pandemic drove an industry-wide staffing shortage that healthcare is still working through, and it changed how home health nurses do the job.

"It also brought infection prevention to the forefront as a primary concern. You were going into a home where you didn't know how sick those people were, or if the patient is worried about you coming into the home as a healthcare provider, so we really had to pay attention to making sure we had the right protective equipment, how to use it and all those infection prevention measures. And then virtual visits became much more frequent and more important as well," Hinck said.

Preparing for the field

Moving into home health isn't complicated. Some employers prefer nurses with a few years of experience, but Hinck said plenty hire new graduates too.

"Some schools of nursing, though not very many, will have home visits as part of their student experience. Whenever that happens, the students who get to do it often really enjoy it," Hinck said. "You can look at the employers in your area, whether it's the hospital-based home visits or home health agencies or hospices."

She also recommends checking the Medicare Care Compare website to look up providers in your area, review their quality indicators, and decide whether one might be a place you want to work.

New or experienced, the constant is honest self-assessment. "If you're going to do a procedure you haven't done in a while, you either need to go through the steps of it or watch a video or do the procedure on a mannequin at your home office so that when you go into the home, you are confident."

If you have the self-starting accountability to keep your skills sharp, home health is a setting where you can do well.