Two-year MassHealth funding will prepare 140 nurses to treat patients in their homes

photo of brenna with the caption Dr. Brenna Morse, Associate Professor in the School of Nursing, led the way in helping the IHP notch a $1.1 million award from the Commonwealth of Massachusetts to train 140 nurses who will treat complex care patients in their homes.

Just months after being awarded a multi-million dollar grant from the federal government to train nurse educators, the MGH Institute is beginning work on a $1.1 million award funded by the Commonwealth of Massachusetts that will train nurses to treat  MassHealth members with medical complexity in their home. 

Administered by the Executive Office of Health and Human Services, the $1.1 million award will train 140 nurses over two years to go into homes and provide care for children and adults who require intensive, continuous skilled nursing support in order to remain at home. The money will begin to fill the gaps in complex home care exacerbated during the pandemic. 

“Just like nurses in the hospital, this nursing specialty wasn't protected from burnout and attrition during the pandemic. This made an already established shortage of nurses in this specialty area even worse, meaning more parents and home caregivers had to quit their jobs to care for their loved ones, or they had to move their loved one to a residential care setting earlier than anticipated,” said Associate Professor Brenna Morse, the principal investigator who wrote the application for this competitive award. “Having nurses to do this important work keeps people with complex conditions in their own communities, growing up in their home, seeing their families, strolling around town, and going to barbecues. In a hospital or long-term care home, it’s a little harder to keep that connection and that personal level of care.”

Approximately 900 MassHealth recipients in the Commonwealth receive these kind of intensive nursing services so that they can stay in their home and avoid living in an institutional setting. But thanks to advances in medical care and technology, those numbers are on the rise. Babies born with complex conditions are now surviving, which leads to a growing need for care through their life span.

woman stands with man in wheelchair in front of alligator
Morse and her patient, Kyle, at the zoo. Kyle and his classmates went on field trips to have some fun and enhance their classroom learning. Here, after learning about different types of animals and habitats at school, Kyle got to go to the zoo and see them in action.

“We look forward to partnering with the MGH Institute in this critically important initiative,” said Mike Levine, Assistant Secretary for MassHealth. “The MGH Institute is well-positioned to strengthen this critical workforce and improve quality of life for the members they serve.” 

Both grants are further evidence of the IHP’s growing footprint in the workforce development landscape. Earlier this spring, the IHP was awarded a nearly $6 million U. S. Department of Labor grant to train more than 220 nurse educators as part of the effort to build up and diversify the nation’s nursing pipeline. 

Geared toward RNs and LPNs– professionals who already have the requisite skills – the complex care nurse training program may appeal to those looking to work in a new area. Those who complete the training will get Nursing Continuing Professional Development credit and a $3,000 stipend.

“Maybe they feel that they've kind of done all they'd like to do in their current job, and they want to try something else,” said Dr. Morse. “It could also be the nurse who's looking to do something part-time on the side as a per-diem job, or a school nurse who wants to do something over their summer when they're not fulfilling that role with the school is closed.”

The curriculum will review skills that nurses already perform in a hospital – such as hooking a patient up to a ventilator, changing a tracheostomy tube, and administering medicine – while providing an elevated level of training to equip them to treat patients in their homes. 

“It might be a review for some, but we're going to strengthen trainee knowledge of the conditions and care specific to the complex care community,” said Morse, who has a PhD in population health nursing and a master’s degree in family health nursing. “We're going to include concepts like the pharmacology, pathophysiology, and assessment of conditions that are common in people with medical complexity.

woman stands with man in wheelchair with child
Morse and Kyle with Morse’s son, Colin.

That first part of the training - 12 modules completed asynchronously online - will be followed by a two-day skill intensive on the IHP campus where nurses will learn first-hand how being a complex care nurse is different than working in a hospital. 

“You're by yourself and you’re doing these really high-level, intensive-care unit-type interventions,” said Morse. “Typically, the parents are the expert in their child's care, but if they're not home, it's just you. Maybe you're trying to do this delicate technical task, and then here comes the family cat, swatting away something you need, and they don't teach you how to address that in nursing school. I think working in this area can be really intimidating for nurses- to be out on their own in someone's house doing all these things without the resources or backup they would have in the acute care setting.”

Additionally, a complex care nurse’s goal is to help someone live the most fulfilling and enriching life possible, something Morse knows well given her seven years of serving in this capacity.

"You might not take clients on a long walk around the neighborhood of a hospital, but when someone is living in their home, you're there to safely facilitate them going to school, taking a walk, going to the movie theater,” said Morse, who also works at Boston Children’s Hospital. “So, those are a couple of things you would do that are different. But nursing-skills wise, it's everything you would do in the hospital setting with the unique challenge of different equipment and home arrangements.”

Morse will incorporate her extensive experiences into the curriculum, and partner with School of Nursing Clinical Lab Coordinator and MGH nurse Jennifer Duran, and Instructor Karen Hunt. The parent voice will be a key element throughout the program as well, something Morse is proud of. 

“Unless you work in this area, you don't realize that when you're not there, the parents are doing the nursing care,” she said. “I think we forget that nursing really is a spectrum: there's licensed nurses, and then there are caregivers in the home that are doing the nursing care. They may not be licensed, but they are the expert in how their family member is best served.

“For the modules, I will talk to these parents about barriers and facilitators - good experiences, bad experiences - that our learners can be aware of and avoid some of those behaviors or actions in the home,” Morse added. “What has made really great partnerships with home nurses, so that they can be ready to do those kinds of things? And then also, if they're my guest for say the pulmonary week, talking about the pulmonary health challenges and how they address them. So, getting the family expert perspective as well as what I'm going to bring from the textbooks.” 

Parents will also serve alongside nurse instructors during the skill intensive sessions.

Morse plans to make this course available for free to any nursing program who wants it. 

“I wanted to make this sustainable and available beyond the IHP because any nurse is capable of doing this, and if they have interest they should get to participate,” said Morse. “I'll be videotaping, and then I'll be sending our recordings out at the end to Massachusetts nursing schools and say, ‘If you want to assign this to an instructor, there is content here for a semester-long course with a clinical intensive. How you decide to allocate credits and grading is up to you, but all the content is here. So, these schools can just have it and hopefully, the program lives on.”

For now, with the program just getting launched, Morse has high hopes. 

“I hope that the nurses enter this line of work because it is so rewarding to help someone go see a movie or join in on a special event - I've gone to a wedding with my client - or the family cookout, which are things that wouldn't be so easy if they lived outside of the family home and didn't have these nurses in the home.

“Adding 140 complex caregiving nurses over the next two years will make a big difference. It won't solve the problem, because of course, we'll still have turnover in the next two years and the population of clients needing these services will grow. But if a family can get one more night of sleep, or enough nursing hours that their loved one can stay in the home where they should grow up and live and be comfortable, I think that’s critical.”

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