No Place Like Home: Advancing the Safety of Care in the Home

No Place Like Home: Advancing the Safety of Care in the Home. IHI Report. Boston, Massachusetts: Institute for Healthcare Improvement; 2018. (Available at

Caring for patients in their homes holds many potential benefits, yet the safety of care provided in the home has not received as much attention as patient safety in hospitals and other clinical settings.

This report describes the findings of an expert panel and considers the physical and emotional safety of the care recipient, the family caregiver, and the home care worker, while recognizing the interconnected nature of the safety of all these individuals.

The report provides recommendations, strategies, and tools for realizing five guiding principles:

  • Principle 1: Self-determination and person-centered care are fundamental to all aspects of care in the home setting.
  • Principle 2: Every organization providing care in the home must create and maintain a safety culture.
  • Principle 3: A robust learning and improvement system is necessary to achieve and sustain gains in safety.
  • Principle 4: Effective team-based care and care coordination are critical to safety in the home setting.
  • Principle 5: Policies and funding models must incentivize the provision of high-quality, coordinated care in the home and avoid perpetuating care fragmentation related to payment.


With support from the Gordon and Betty Moore Foundation, IHI conducted this project to better understand the scope of patient safety issues in the home setting and identify strategies and best practices for improvement. Following the completion of a landscape analysis, IHI convened a multidisciplinary expert panel to consider the challenges and opportunities related to advancing patient safety in this area and develop strategic recommendations for moving forward. This report is the result of the panel’s work.

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