It’s easy to think of hospital-at-home as a new model, but it’s not all that new. Johns Hopkins provided the first program more than 25 years ago. We actually can thank the pandemic for thrusting the hospital-at-home concept into the limelight, prompting the government to issue a waiver to expand the program.
Now it seems to be the talk of the industry, with the growth of hospital-at-home projected to fuel the shift of up to $265 billion of Medicare services from facilities into home settings. You can’t go to a conference these days without seeing a session on this issue and how providers can get a piece of the action.
It’s hard not to be a little gaga over the concept, which essentially lets people undergo their hospital stay at home after an in-hospital assessment. (I can only imagine how it must feel to be rushed to the hospital and find out you can actually go home to get better.) As Mark R. Montoney, M.D., advisory board member of MediGuru, explained to me this week, the program offers several advantages to seniors.
“They can stay in a familiar environment, have less exposure to health-acquired infections, and it proves to be a high patient satisfier,” said Montoney, a geriatrician. “They’re able to be at home with loved ones and pets. The healing process can be accelerated when they’re in a familiar environment.”
The program can accommodate patients who would normally be admitted to general medical beds — not for intensive care, he explained. Some of the conditions suitable for hospital-at-home include Chronic Obstructive Pulmonary Disorder and congestive heart failure exacerbations, pneumonia, urinary tract infection, cellulitis and dehydration. He added that less-acute COVID-19 patients also might be good candidates for such care.
Montoney noted that as part of the assessment for hospital-at-home, clinicians look at the home environment and loved ones’ support. Extended nursing visits happen for two to three days. A virtual care unit staffed by clinicians allows for remote monitoring throughout the entire episode of care.
“I would suggest these patients get great hands-on care and virtual care,” Montoney said.
There is also oversight of meals and an understanding of all the medications the patient is taking, including herbal supplements, he said.
Still, hospital-at-home may be a work in progress. A guest column published this week on McKnight’s Home Care pointed out that hospital-at-home puts more burdens on family caregivers who get tasked with caregiving duties for the patient at home. The workforce shortage has compounded personal caregivers’ responsibilities, the authors contend.
The authors raise great points. Sure, who wouldn’t want to be home? But if it is on the backs of family caregivers, who bear so much of the brunt of caring in this country, the concept needs some fine-tuning. We all know that hospitalizations and rehospitalizations are the root of so many health problems. Given the capabilities of remote technology, hospital-at-home holds incredible potential. It’s worth tweaking it to make sure it works for everyone.
Liza Berger is editor of McKnight’s Home Care. Email her at [email protected].