Bridging the Gap: How Understaffed Home Nursing Influences Family Wellbeing and Acute Care for Children with Medical Complexity

For families raising children with medical complexity, home is often both a sanctuary and a treatment center. But when home nursing support is inadequate, that sanctuary can quickly become a site of escalating stress, financial instability, and avoidable medical crises. A growing body of research is now shedding light on just how consequential these care gaps are—not only for family wellbeing but for broader healthcare utilization patterns.

Recent studies confirm that families receiving less than half of their authorized home nursing hours experience significant financial burdens. These families frequently absorb the costs of additional caregiving responsibilities themselves, leading to lost wages, reduced employment opportunities, and mounting emotional strain. In many cases, one parent is forced to cut back on work or leave the workforce altogether to fill the void left by understaffed nursing shifts. The result is a destabilized economic foundation for households already managing intense caregiving demands.

This issue is especially pressing in pediatrics, primary care, and health policy circles, where calls are growing louder to reassess and restructure how support is delivered to families managing complex, round-the-clock care needs. These families often rely on home nursing to monitor vital signs, administer medications, manage feeding tubes, and perform other skilled tasks critical to a child’s daily survival. When those hours go unstaffed, the responsibility defaults to the family, stretching them thin—both financially and emotionally.

A study published in Health Affairs sharply illustrates this dynamic, revealing a clear correlation between insufficient nursing support and increased out-of-pocket costs. The financial pressure, in turn, negatively affects family functioning and overall wellbeing. These findings suggest that restoring adequate home nursing services is not simply a matter of convenience—it is a vital intervention for maintaining family stability and improving health-related quality of life (HRQL) for both the child and their caregivers.

Beyond financial hardship, inadequate home nursing has ripple effects in how families engage with the healthcare system—particularly in their use of acute care services. Surprisingly, research has found that families in the mid-range of acute care usage report better HRQL than those with minimal encounters. This counterintuitive finding suggests that limited access to acute care, when combined with insufficient home support, may actually elevate stress and deteriorate family functionality. In contrast, timely and appropriate acute care use—paired with reliable home nursing—may serve as a pressure-release valve, helping families manage crises before they escalate.

These insights underscore the need for a more integrated approach to managing care for children with medical complexity. Strengthening home nursing services isn’t just about keeping families afloat financially—it’s also about reducing unnecessary emergency visits and hospital admissions. With more consistent support in the home, families are better equipped to manage routine care, spot early warning signs, and prevent complications, thereby easing the overall burden on the healthcare system.

Policy experts and clinicians alike are now advocating for targeted reforms. Strategies include increasing Medicaid reimbursement rates to attract more home nursing staff, investing in workforce development for pediatric home health, and implementing flexible care coordination models that adapt to the evolving needs of families. These changes require thoughtful resource reallocation, but the potential returns—in family resilience, system efficiency, and patient outcomes—are substantial.

A policy statement issued by the American Public Health Association (APHA) echoes these priorities, emphasizing the importance of structural solutions to support home care delivery. It calls for enhanced funding, stronger care integration, and standardized assessments to ensure families receive the nursing hours they are authorized—and need.

Ultimately, the research draws a clear line between staffing shortfalls in home nursing and downstream impacts on family economics and acute care patterns. Addressing these gaps is more than a clinical responsibility—it’s a policy imperative. As healthcare systems continue to embrace value-based care and family-centered models, ensuring reliable home nursing for children with medical complexity must be at the forefront of reform efforts. Without it, the cost of care will continue to fall on those least equipped to bear it.