Home Health Care of Children, Adolescents and Young Adults With Complex Medical Needs: Clinical Report

The majority of children, adolescents, and young adults with complex medical needs, especially those who use life-sustaining equipment, are cared for at home by their families and community. Home health care is an essential service that supports families to be able to safely care for their children outside of the hospital, and the medical home serves as the hub to help coordinate and communicate between providers and families. It is essential that pediatric health care providers develop and implement an interdisciplinary and coordinated plan of care that addresses the child's ongoing health care needs. The goal is to ensure that each child remains healthy, thrives, and obtains optimal medical home and developmental supports that promote ongoing care at home. Discharge planning from long-term hospitalizations and rehabilitation for this population can be a complicated process that requires a deliberate, multistep approach. This clinical report presents an approach to addressing the needs of children with complex medical needs and their families in the home environment and supporting the transitions between hospital and home.