Clinicians call for safe work-hour limits for parents caring for children with high medical needs at home

By Louise Kinross

Parents caring for children with serious, sometimes life-threatening, conditions at home need safe work-hour standards similar to those seen in high-risk work such as nursing, aviation and trucking, according to a viewpoint piece in JAMA Network this week.

The authors note that parents of children with high medical needs spend, on average, up to 52 hours a week providing care at home, with more complex conditions requiring more hours. This exceeds what is considered safe in industries where fatigue can impair performance and increase the likelihood of errors.

The authors, who include two pediatricians and a social worker, say parents should be protected by similar limits on work hours, to safeguard their, and their child's, wellbeing.

They propose five policy changes: Develop clear work-hour safety standards for parents who provide home caregiving, looking to limits already set in safety-sensitive industries; engage parents in setting the new standards; develop a national at-home adverse event registry to understand how frequently adverse events occur, particularly when parents lack appropriate home nursing support; develop policies and programs, with needed funding, to address systemic and structural problems that limit the supply of high-quality home nurses; and educate clinicians on unsafe work hours and reasonable expectations for parents.

"With better home care seen as a way to prevent hospitalizations, facilitate discharges, and improve outcomes, we need to think about and safeguard parental caregiving work with the same scrupulousness that we afford other areas of health care," the authors write.