Inspired by the Covid-19 pandemic, healthcare leaders and organizations alike have been working tirelessly to develop easier ways to deliver care in patient homes. In November 2020, the Centers for Medicare and Medicaid Services (CMS) launched the Acute Hospital Care at Home (AHCAH) initiative, which enabled Medicare-certified hospitals to treat patients with a higher level of inpatient care at their homes. Recently, this initiative has been extended by Congress until September 2030, signaling a win for hospital-at-home enthusiasts and patients.
Why is this important?
Hospital care at home enables patients to receive care that they could not otherwise access without physically being in the ward or at an inpatient unit. As the American Medical Association explains, this often requires having the appropriate screening protocols and entry/exit gates, frequent monitoring by nurses, routine checks by physicians, frequent patient-safety metric tracking, and maintaining a low threshold for emergency transport or escalation of care services. Studies have indicated that hospital at-home care actually helps reduce mortality and costs for care services; specifically, hospital care at home episodes were associated with lower Medicare spending in 30-day post discharge period, compared to traditional inpatient stays; furthermore, they were also associated with lower mortality rates than traditional hospital stays.
An additional report by the American Telemedicine Association explains that at-home care promotes significant benefits, including avoidance of hospital acquired infections; lower rates of mobility decline and delirium; reduced caregiver strain; and perhaps most importantly, better outcomes associated with a more familiar setting for the patient.
Of course, there are some challenges with at-home hospital programs. Most importantly, systems and local communities need to have the infrastructure and capabilities to implement these programs, as they can require a heavy resource investment at the start. For example, on-demand nursing care and physicians that can visit patient homes must be available, which is challenging to do in an already stretched labor force. Additionally, these systems are even harder to establish in rural areas where access to a critical care center or nearby inpatient unit may not be feasible; incase of actual emergencies or if the patient needs to be transported to a higher level of care, this could pose a dire problem that may lead to catastrophic mortality and outcomes. Finally, perception matters as much as the treatment. For many individuals, the perception of receiving care at home may be different than that received in a hospital, leading to poorer outcomes. Despite standardization of admission and escalation protocols, patients who may not perceive their care as equitable to their inpatient counterparts can have significant challenges in their recovery period, in addition to losing trust in their care teams and support structure.
Therefore, hospital-at-home care may not be ready to launch at full scale nationwide, just yet. Nonetheless, the recent developments in this arena are positive steps forward toward fueling more research, access and knowledge about this concept.
