What is a Hospital-at-Home Program?

Hospital-at-home programs have been gaining momentum in recent years. In this guide, we’ll answer the following questions: what is a hospital-at-home program? How do they work? Who do they help?

Hospital-at-home programs aim to deliver hospital treatment and monitoring to patients in their homes. These programs are sometimes offered with mobile integrated health professionals like community paramedics or home health nurses. Successful hospital-at-home programs help lower costs, improve patient outcomes, and reduce ER visits.

Let’s take some time to examine these hospital care at home programs in detail—we’ll examine who they are for, how they operate, and some of the struggles they face going forward.

How Does a Hospital-at-Home Program Work?

In the following sections, you’ll discover some common pillars that hold up these home hospital programs. Before discussing the benefits of hospital-at-home programs, let’s cover how they operate. While there are some universal features to these programs, remember that each program will operate a little differently by design.

Here are some of the features of a hospital at home program:

  • Focusing on a specific patient group (COPD, CHF, Diabetes)
  • Home assessment
  • Admitting patients from the ER/MIH-CP
  • It’s made possible through telehealth.

Let’s go over these points in more depth.

Treatment for a Specific Patient Group

Hospital-at-home programs often start by recognizing the needs of a patient group that would be a good candidate for the program. Of course, there are some patients who will never be good candidates for a hospital-at-home program. That said, some diseases present with a relatively predictable treatment pattern, making these patients suitable for the program.

Often, the patients who are good candidates for the program are those struggling with chronic illnesses, such as COPD or CHF. The hospital-at-home program can effectively manage these patients without the need for prolonged, in-hospital stays.

Let’s talk about what happens next.

Home assessment

Those patients deemed candidates for the program will be assessed in several ways. First, they will be given the option to participate or not. Some patients may not be comfortable with advanced care in the home; however, this is not a huge issue in most cases.

Second, a home assessment will be conducted after a patient agrees to participate. A home won’t have the same resources as the hospital, but it does need reliable heating and cooling, good internet, handlebars and ramps if needed, and a proper bed. The goal is to ensure that the patient can be safely and effectively treated at home.

Admitting Patients from the ER

How does a patient enroll in the program? This usually happens in several ways. First, the patient might be a referral from the ER. The physician will perform an initial assessment and determine if the patient can be admitted to the hospital-at-home program.

Community paramedics may also refer patients to the program. Often, the patients referred need frequent care and utilize emergency services more than others.

After the patient is accepted to the program, they will be transported home using appropriate means. Now, the treatment begins. Let’s talk about how this works.

It’s Made possible through Telehealth

So, how does the care work when the patient is at home? This is a common question, as it might be assumed that providers will be limited. As you’ll see, some creative ways make care possible.

First, much of the care is anchored on telehealth and daily home visits. The physician assesses the patient via video call, often facilitated by an in-person provider, such as a home health nurse or community paramedic. The physician can monitor the patient’s vitals in a similar way to the hospital.

Second, more treatments can be provided in the home than many people think. Aside from serious surgical procedures, many common procedures can be safely performed in a patient’s home. These treatments include respiratory treatment, IV medications and hydration, wound management, and post-surgical care.

Now, let’s talk about some of the benefits observed from hospital-at-home programs.

What are the Benefits of a Hospital-at-Home Program?

Now that we know more about how hospital-at-home programs work, let’s discuss some benefits health systems have observed after implementing these programs. As you’ll notice, many of these benefits are similar to those of mobile integrated healthcare programs.

Here are the benefits of a hospital-at-home program:

  • Reduced ER visits
  • Better patient outcomes
  • Lower costs of care

Now, let’s unpack the details.

Reduced ER visits

Some systems saw fewer ER visits from patients who enrolled in the program. Sometimes, the number of patients who saw a decrease in ER visits approached 50 percent. This is significant, and it means less strain on the providers and better care for patients in life-threatening emergencies.

Not only that, but it means the patients receive the care they need. Fewer ER visits suggest that the patient’s chronic conditions are being effectively managed, which translates to reduced costs for both the patients and the providers.

Now, let’s talk about outcomes.

Better Patient Outcomes

Many people might assume that hospital-at-home programs are inferior in terms of care. However, several reviews have found the opposite. Some studies have seen a 20% decrease in the mortality rate among patients enrolled in a hospital-at-home program.

Why is this? It could have to do with many factors. One of the intangibles could be that patients are happier in their homes. They can continue their routines and visit with family. On a more measurable note, there may be less chance of infection – this applies to the small scale, with local infections around open wounds, and the large scale, with viruses such as coronavirus and the flu.

Lower Costs of Care

It also appears that hospital-at-home programs reduce the costs of caring for the patient. Whenever costs are reduced, there’s a win-win: The hospital can be more efficient with resources, and the patient does not have a serious financial burden.

Some reviews have suggested that a hospital-at-home program can have up to a 25% lower overall cost. The cost reductions have been similar to those seen in MIH-CP. If you’re curious, check out this guide on how community paramedicine reduces ER visits and Medicaid costs.

While these programs offer many benefits, this does not mean they are without difficulties in implementation. In the next section, we’ll discuss some of the challenges these programs face in gaining more widespread adoption. 

What are the Challenges Facing Hospital at Home Programs?

While hospital-at-home programs seem like a proven concept, much work remains to improve their adoption in the USA. In this section, we’ll discuss some of these programs’ challenges and how health systems might overcome them.

Of course, each area will have unique challenges that will need to be overcome. If you’re considering implementing a hospital at home program, take some time to think about the specific struggles in your area.

Here are a few challenges facing hospital-at-home programs:

  • Finding trained staff: Many health systems struggle to maintain their current staff, so they find it very difficult to train and send more trained nurses and paramedics into the field. In the coming years, more resources will need to be dedicated to training and retaining health professionals.
  • Paying for the program: many insurance providers won’t reimburse hospital at home programs. This leaves many hospitals to find reimbursement elsewhere, often in their own health plans. Moving forward, there will need to be greater opportunities for sustainable reimbursement.
  • Education of the public: Many people are highly enthusiastic about hospital-at-home programs. That said, some may still not trust that they are receiving the same caliber of care. More work will need to be done to give patients and family members full peace of mind.
  • Coordination among providers: Hospital at home programs require careful communication and collaboration among health providers. Unfortunately, there are still many barriers to communication between health providers, with many who don’t have the right resources or don’t fully understand the privacy laws around collaboration with other providers.

Now, let’s go over a quick wrap-up and a few closing thoughts.

Final Thoughts: The Future of Hospital-at-Home Programs

Hospital-at-home programs are springing up all around the country. These programs will carefully choose patients who qualify for the programs and then administer the care via telehealth technology and field-based care providers.

Many areas have seen decreased ER visits, reduced costs, and better patient outcomes. However, even with all the good results, many areas still struggle to find good providers, fund the programs, and stay connected with their partners in the field.

Contact Julota to learn how their interoperable software can keep your community health program connected. Julota’s secure data collection software can help you document patient encounters and improve collaboration efforts with fellow providers.