Back in 2017, we posted about “Point of Care” (POC) and how it applies to healthcare. Briefly, POC is the treatment of a patient at their location. Well, you can’t get any more POC than a patient’s home. Treating them there is called “hospital at home,” and has several distinct advantages over in-hospital care ranging from lowered costs, greater patient satisfaction, to managing COVID-19 cases.  

Bringing the Hospital Home 

Hospital at home (HaH) is defined by John Hopkins Medicine as a program that delivers hospital-level care to a patient at their residence. The concept is not new, and is quite common in countries with single-payer health services like the UK, Canada, and Australia. Observant readers probably picked up why it is absent in the US. The advantages, which we’ll cover in a moment, have led various private entities like schools to establish such programs in the states. John Hopkins Medicine’s trademarked “Hospital at Home,” which was started back in 2002, is probably the most recognized one.

This changed, like many things in healthcare, with the onslaught of the COVID-19 pandemic. In late 2020, Medicare, which is the closest thing to universal healthcare coverage in the US, announced it would start reimbursing various HaH programs. According to the federal agency, this would help free scarce hospital beds for acute COVID-19 cases. HaH advocates were delighted and, like proponents of telehealth, are now working to make such reimbursement programs permanent.   

At Home Care Advantages 

There are reasons to be hopeful. The American Hospital Association, drawing up studies from the American College of Physicians, the Medical Journal of Australia, Mount Sinai, and John Hopkins (of course), just to name a few, showed hospital at home care to be effective at:

  • Freeing up critically needed hospital beds. Patients even with medium acuity issues such as chronic obstructive pulmonary disease (COPD) and heart failure, which are normally treated with a lengthy hospital stay, can do so at home. That now empty bed can thus be occupied by patients needing round-the-clock observation and treatment (e.g., a COVID-19 patient in acute respiratory failure).
  • Addressing patients in rural areas. Such patients don’t have to trek to hospitals which may be hours away for treatment or even follow-up. Instead, they’re cared for by local paramedics who are guided remotely through telemedicine by the hospital physician. 
  • Reducing costs. At-home care has been documented to reduce medical expenses by up to 25 percent on average compared to in-hospital care. 
  • Avoiding HAIs. Patients in HaH programs, obviously, don’t have to worry about hospital-acquired infections (HAI). That doesn’t mean the medical computer at their home shouldn’t have properties like an antibacterial housing or fanless. Bacteria and dust can be found in the interior of homes, too. 
  • Helping patient recovery faster. Patients who go through HaH care have a 20 percent lower morbidity rate and are three times less likely to suffer readmission. 
  • Satisfying patient mental health. Studies from patients, their families, to caregivers, have consistently shown greater satisfaction with the programs, with one study showing 90 percent satisfaction from patients in HaH versus 67 percent in hospital care.

Hospital at Home, Step by Step 

So let’s say you’re interested in HaH care either personally or for your business. How does it work, exactly? Here’s what to expect based on the Hospital at Home™ program developed by John Hopkins Medicine:

A potential candidate

The patient is assessed in the ER to see if they’re a good candidate for the program. Illnesses like pneumonia, congestive heart failure, diabetes, cellulitis, and even less acute forms of COVID-19, are all treatable in HaH settings. 

Home is where the health is

A physician versed in HaH evaluates the patient as well as meets with their family and support personnel like caregivers. Together, they also determine if the patient’s home can accommodate such care (i.e., is clean, has HVAC, has sufficient power for medical devices, connectivity such as Wi-Fi, and running water). 

From bedroom to hospital room

The patient is “admitted” to their residence, i.e., transported back home usually by ambulance. Any necessary medical equipment like blood pressure and heart rate monitoring systems, medical panel PCs, and workstation on wheels, are set up. Such biometric systems provide constant information on the patient’s condition to clinicians and RNs (see below). 

Housecalls 21st century-style

Nurses will visit the home daily to check on the patient, and administer any necessary treatments and medications. A physician may do so as well, either in-person or virtually via telehealth. Mobile devices allow in-home care patients to reach either RNs or clinicians, who are available 24/7 for urgent calls and emergencies. (As an aside, said devices are usually iPads, which we don’t recommend for various reasons. Instead, we urge a medical tablet equipped with such features as an antimicrobial* surface to protect the computer casing from deterioration and degradation, IP65 rating for easy cleaning of the screen, and high-performance batteries.)

Just a quick trip

If the patient needs a specialized study like an X-ray, a mobile imaging company is arranged to do so at their home. Otherwise, arrangements are made for a brief visit at the nearest equipped medical facility. 

You may now go home. Which is your living room

The patient in the hospital at home program is treated until their condition is stable. They are then “discharged” to go back home, which can be the same room they were in during HaH! They’re also referred back to their primary clinician and any specialists for follow-ups.

Closing Thoughts

Programs to bring Hospital at Home to the US have been primarily halted due to payment issues. Thankfully, both the public and private sectors are seeing the benefits, and are looking for ways to make such programs more readily available as an alternative to the lengthy ﹘ and even more costly ﹘ hospital stay. Contact the experts at Cybernet if you’re looking for solutions for your hospital at home program.

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