Toward a Comprehensive Care Intensity Instrument for Home Healthcare: Integrating Patient and Nursing Determinants

Introduction: An aging population and increasing care complexity are placing growing pressure on home healthcare services worldwide. Rising demand, nurse shortages, and high workloads risk reducing patient satisfaction and care quality, potentially leading to poorer outcomes. Accurate assessment of care intensity is essential for efficient resource allocation and optimal nurse–patient alignment. Objective: Beyond improving care delivery, insights in care intensity can also play a key role in supporting nurse-retention strategies. Existing tools, such as the Katz Index and BelRAI, omit several critical determinants. This study examines these gaps and outlines directions for developing a more comprehensive care intensity instrument (CII) for home healthcare. Methods: A narrative review was conducted to examine existing CIIs in home care and to identify missing determinants. Additional insights were obtained through expert consultation and field engagement. Instruments were analyzed to determine which determinants are currently captured in widely used assessment tools. Results: Eight CIIs currently validated or used in Belgian home healthcare were identified. Their coverage of patient-related determinants varied: physical health was consistently assessed, whereas mental and behavioral aspects received less attention, and social or environmental factors appeared in only a few tools. Nursing-related determinants—such as workload, skills, work environment, and demographics—were mostly absent. Conclusions: None of the instruments provided a fully comprehensive assessment integrating both patient and nursing determinants. This narrative review, complemented by expert consultation and field engagement, highlights the need for a CII that integrates patient determinants with nursing determinants to improve the quality, safety, and efficiency of home healthcare.