Improving patient care by integrating social determinants of health into home care nursing practice

Home care nurses occupy a unique position in the health care system, observing patients in their living environments and coordinating care across multiple delivery sites. Social determinants of health (SDoH), encompassing economic stability, education, health care access, neighborhood conditions, and social context, account for an estimated 30% to 90% of health outcomes, far exceeding the contribution of medical care alone. This article examines the historical, organizational, and clinical foundations of SDoH within the context of home care nursing, underscoring the critical need for systematic assessment in patient care to ensure positive health outcomes. Drawing on the upstream, midstream, and downstream framework, this article describes how home care nurses can intervene at multiple levels: advocating for systemic change, connecting patients to community resources, and managing individual clinical and behavioral needs. The article also examines evolving policy and documentation requirements, including mandatory SDoH screening and the underutilized ICD-10-CM Z-codes, while highlighting gaps in social work utilization. The article further explores emerging models such as social prescribing as promising multilevel approaches to meeting patients' social needs. Ultimately, addressing SDoH is both a professional and ethical obligation for nurses, one that demands interdisciplinary collaboration and sustained commitment across all levels of care.