When the patient ward is your living room: Trends in hospital-at-home programs
By Julia Métraux, Health Equity Fellow
To address the hospital bed shortage and patients’ desire to recover in a familiar environment, a growing number of hospitals are offering at-home-care programs, either in lieu of hospital admission or following acute inpatient treatment.
During HJ25, Los Angeles General Medical Center Chief Medical Officer Brad Spellberg, M.D.; The Permanente Medical Group Associate Executive Director Vivian Reyes, M.D.; and Chad. R. Nelson, M.D., chair of the Division of Hospital Internal Medicine at Mayo Clinic Arizona, shared how their respective hospitals and hospital systems are approaching this new model of care.
How it works
In at-home-care models, patients are provided with remote monitoring tools such as a wireless blood pressure cuff, pulse oximeter, thermometer and digital scale to track vital signs and other data. They check in daily with a care team member via video or in-home visits.
To participate in the Mayo Clinic’s program in Phoenix, patients must live within 30 minutes of the hospital, Nelson noted. Before the start of the program, Mayo Clinic Arizona frequently exceeded capacity in hospital beds, according to Nelson.
“CMS does have the acute hospital care at home waiver program,” Nelson said. “You now can get reimbursed for caring for your patients at home, the same as you would as if they were in the brick and mortar [hospital].”
The command center for the program is in Florida, and the care patients receive, Nelson said, “is very personalized.”
Permanente Medical Group started to develop its program in 2018 because the medical group “knew that patients were getting sicker and more complex” with an aging population, Reyes said.
“What we do is we wrap around the patient all the services that they need,” she said. “That means 24-hour access to nursing care, physician care,” and services like an ultrasound “will come to your home.”
Los Angeles General Medical Center, which primarily serves Medicaid and uninsured patients, started its program in response to the COVID-19 pandemic. It has since expanded to treat issues including asthma exacerbations, kidney infections and pneumonia.
“There was no difference in mortality,” Spellberg said. “There was actually a statistical decrease in emergency department re-visits.”
All panelists emphasized how they’re receiving positive feedback on their programs from participants and their caregivers.
“Patient satisfaction is through the roof,“ Reyes said. “The reason for that is because patients are getting the care that they need surrounded by their family and their pets.”
Julia Métraux is Mother Jones’ disability reporter and an AHCJ Health Equity fellow.
