Popular Programs Blur the Line Between Home and Hospital

Experts have predicted that people’s homes will become the primary setting for health care in the United States within 10 years, and it appears hospitals themselves may help make this a reality by offering “hospital at home” options.

Mount Sinai Hospital in New York City and Presbyterian Healthcare Services in Albuquerque, N.M., are among those exploring this type of care. Both were featured in a recent New York Times article on the trend, which is proving popular among patients like Martin Fernandez. The 82-year-old recently was able to receive hospital inpatient-level care in his own Manhattan home for a urinary tract infection.

The idea is that the home is a safer and more restful place than the hospital, as there is less risk of contracting an infection and there are fewer alarms and other disruptions. While receiving inpatient-level care at home is not possible for all diagnoses, some conditions respond well to in-home treatments, advocates say. For example, while ventilators cannot readily be installed in private residences, intravenous fluids can be administered there and even X-rays can be taken. 

One of the pioneers of the hospital at home movement is Bruce Leff, M.D., a geriatrician and professor at Johns Hopkins University School of Medicine. His early experiments at John Hopkins revealed that patients who received hospital-level care at home tended to be discharged earlier, were less likely to be readmitted, and were less likely to receive sedatives or develop delirium, according to the Times. Their treatments also cost less.

“My sense is that over time, hospitals will become places that you go only to get really specialized, really high-tech care,” he told the Times. At least one-hundred hospital administrators have contacted him in the last two years to ask about implementing hospital-at-home programs, he noted.

Leff’s comments are similar to those made by experts at a workshop on the future of home health care convened by the Institute of Medicine and National Research Council. New technologies and changes in health care policy should make home- and community-based care the “default” and hospital care “the exception,” said Eric Dishman, general manager of the Health Strategy & Solutions Group at tech giant Intel.

Health care policy still has a long way to go to support more widespread in-home care, the Times pointed out. For instance, Medicare fee-for-service still does not reimburse for the type of of hospital-at-home program pioneered at Hopkins, in which the hospital’s own physicians, nurses and other staff furnish care.

Yet there are signs that this could be changing. Mount Sinai’s program is funded by a nearly $10 million grant from the Centers for Medicare & Medicaid Services. Patients who elect hospital-at-home services will be tracked for a month after their official discharge, during which time they will continue to have access to health coaching and home doctor visits. Investigators then will compare the patients’ outcomes and satisfaction levels against a group of people who received traditional in-hospital care.

“I am very confident that we’re going to be able to show that patients want to be home, that we can do this safely, and that we can do this with savings,” Linda DeCherrie, M.D., an associate professor of geriatrics and palliative care medicine at Mount Sinai and clinical director of the new program, told the Times. 

Written by Tim Mullaney