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A cross-sectional study of 250 patients and informal caregivers served by two New York home health agencies examined household conditions that can affect infection prevention. Researchers found poor lighting was the most common observed hazard, followed by vermin infestation; the study also linked difficulty paying medical bills with greater environmental hazards and clutter. The findings point to possible needs for structured home assessments and additional support, but do not establish that household conditions caused infections.
A study of 250 home health patients and informal caregivers found that household conditions such as poor lighting, vermin and clutter can complicate infection prevention in home-based care, according to research published in the American Journal of Infection Control. The findings highlight practical challenges for clinicians delivering care in homes that do not have the controlled environment of a clinic or hospital.
Researchers recruited participants through two Medicare-certified home health agencies in New York. The survey included 132 care recipients, or 52.8% of respondents, and 118 informal family caregivers, or 47.2%. The average respondent age was 63.5. Trained research assistants visited patients’ living spaces and rated five conditions relevant to safe care: clutter, poor lighting, infestation, hoarding and dirt or grime.
The report said participants generally lived in clean homes with moderate amounts of clutter. Among the hazards assessed, poor lighting was most common, followed by vermin infestation. Researchers defined clutter by how much of a surface was clear; hoarding was treated separately and described as clutter that makes a space unusable for its intended purpose.
The study also examined social factors. Participants who said they had trouble paying medical bills had greater reported risks from household hazards and clutter, lead author Margaret McDonald told Home Health Care News. The report described associations between some participant characteristics and home conditions, including an association of older age, Hispanic identity and more favorable attitudes toward infection prevention with greater cleanliness. These findings describe relationships in the sample; they do not establish why those conditions occurred.
Home Conditions Shape Care Delivery
Home health workers provide clinical care in environments they do not control. A crowded counter may leave little usable space for supplies, while dim light can make it harder to see during care tasks. Infestation or dirt may pose additional practical challenges. The study did not measure infection outcomes, but it shows why infection-prevention procedures may need to account for the specific conditions inside each home.
For patients and families, the results point to a potential gap between clinical instructions and the resources or space needed to follow them. McDonald suggested that agencies could use a structured checklist to identify people who may need extra home support. Social workers may be able to connect families with cleaning, decluttering or home aide services. Those responses are recommendations reported by the lead author, not interventions tested by this study.
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How Researchers Assessed Homes
The research focused on infection prevention and control in home healthcare, where providers work in patients’ living spaces rather than dedicated clinical rooms. The team used in-person surveys and ratings from one to five for the conditions they assessed. For clutter, a space rated as having no clutter was 90% to 100% clear; a very cluttered space was 0% to 49% clear. The researchers distinguished this measure from hoarding, which they defined by whether clutter prevented a space from serving its intended purpose.
McDonald, the study’s lead author and associate vice president of the Center for Home Care Policy and Research at VNS Health, told Home Health Care News that people receiving home healthcare are often medically complex and do not have the same environment as outpatient settings. VNS Health is a New York-based provider of home health, hospice, palliative and other services. The study’s findings reflect participants connected to two agencies in that region, rather than a national sample.
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Limits of the New York Sample
The study was cross-sectional, meaning it captured conditions at one point rather than following homes or patients over time. It included 250 respondents connected to only two New York agencies. The report does not establish that a particular hazard caused an infection, quantify infection risk attributable to each condition, or show whether a checklist or added services improve outcomes.
Researchers also found that some results differed from their expectations. McDonald said the team had expected greater neighborhood deprivation to correspond with more observed home hazards, but that was not what they found. The report does not provide enough information to determine how the findings would apply to other regions, agencies or patient populations.
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Screening and Support Options
McDonald said home health providers could consider more structured ways to identify households where hazards may complicate care. A checklist could flag needs for follow-up, while social workers could help families seek cleaning, decluttering or aide services. The report presents these as possible approaches; it does not say that agencies have adopted them or set a timeline for implementation.
Further research would be needed to test whether such assessments and support services change care conditions or infection outcomes, and whether the patterns found in this New York sample hold elsewhere. For now, the study offers evidence that providers should assess the home environment alongside clinical and social needs, while the scale of any effect on infections remains unknown.
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Key Questions
What did the study examine?
It assessed five household conditions that could affect infection prevention during home healthcare: clutter, poor lighting, infestation, hoarding and dirt or grime.
Which household hazards were most common?
Poor lighting was the most common hazard observed, followed by vermin infestation. Researchers said participants generally kept clean homes with moderate amounts of clutter.
Did the study show that household hazards cause infections?
No. The study examined home conditions and infection-prevention challenges, but it did not establish that hazards caused infections or measure the infection risk associated with each condition.
Who took part in the research?
The study surveyed 250 people connected to two Medicare-certified home health agencies in New York: 132 care recipients and 118 informal family caregivers.
What responses did the lead author suggest?
Margaret McDonald suggested structured checklists to identify households needing added support and said social workers may help connect families with cleaning, decluttering or home aide services. These were proposed options, not interventions evaluated by the study.
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