With Hospital Beds in Short Supply, Avera Health Turns to Versatile Home-Based Care Program

The idea that the home setting could serve as an alternative care site — taking the pressure off of hospitals facing over-capacity challenges — really took flight in the midst of the COVID-19 emergency.

In some ways, large health systems with home-based care arms were able to navigate this shift more seamlessly.

As another COVID-19 surge sweeps across the U.S., Avera Health’s Avera@Home COVID Care Transitions program, for example, has been an asset when it comes to providing care and preventing adverse health events.


Sioux Falls, South Dakota-based Avera is a health system with more than 19,000 employees and physicians. The company — South Dakota’s largest private employer — has over 300 locations across five states.

For Avera, caring for patients in the home setting has long been part of the company’s toolbox. The company first established its Avera@Home Care Transitions program eight years ago, with the goal of reducing hospital readmissions and emergency room visits.

Under the program, the company provided skilled nursing services, physical therapy, telehealth, occupational therapy and more.


When the public health emergency continued to worsen, Avera, like most health care organizations, looked to preserve hospital resources such as personal protective equipment (PPE). Creating its Avera@Home COVID Care Transitions program, which leverages telehealth, allowed the system to do this.

“When COVID came about, we were concerned about PPE limitations,” Dr. Chad Thury, medical director of Avera@Home, told Home Health Care News. “We still service our patients at home that need it, … but for the most part, we are monitoring our COVID patients through home monitoring, software products, phone calls and virtual visits. That has allowed us to ramp up and make our home care team much more efficient.”

Being a large health system gave Avera the resources the company needed to get its program off the ground immediately, according to Thury.

“We had a strong home health division with our Avera@Home business unit,” he said. “We also have [home medical equipment] stores throughout our region, so we were set up to get patients oxygen, pulse oximeters and stuff like that.”

Avera’s prior efforts to increase home monitoring among its post-discharge patients — congestive heart failure, in particular — also ensured that the company had the infrastructure in place to care for COVID-19 patients at home.

The Avera@Home COVID Care Transitions program focuses on monitoring and caring for patients categorized as “moderately sick.”

“As they progress in their symptomatology, we can get them an oxygen monitor. We can even get them oxygen,” Thury said. “We can have them on oxygen for a number of days, being monitored at home, instead of having to put them in the hospital.”

Ultimately, that allows Avera to save hospital beds for patients who have more severe symptoms and require higher levels of care.

In addition to its Avera@Home COVID Care Transitions program, Avera set up a 24-hour COVID-19 hotline in March. The hotline allows patients to call for information on testing and treatment.

Overall, Avera has treated 3,000 COVID-19 patients through its Avera@Home COVID Care Transitions program. Just 5.3% of those patients have required hospitalization.

“Every day our nurses get a list of their patients,” he said. “They know which ones are Tier 1, meaning high-risk, symptomatic, a lot of comorbidities, oxygen is going down. Then you have Tier 2, meaning moderate risk, maybe a little symptomatic. Tier 3 patients are high-risk, but they’re maybe not having symptoms yet, or they’re just mildly symptomatic.”

Another thing that benefited the program was utilizing a language line to provide interpretation services. Roughly, 26% of Avera’s COVID-19 patients spoke languages other than English.

“In South Dakota, part of our initial rise in COVID cases was related to a protein plant,” Thury said. “A lot of the workers there are people that have immigrated to the United States, so they speak multiple different languages.”

As part of these efforts, the health system also worked with its marketing team to develop medical information materials in multiple languages for patients.

Another population Avera needed to navigate caring for was the local homeless community, according to Thury.

“Providing home-based care to the homeless population was difficult,” he said. “We have a community health center in Sioux Falls that we were able to work with. We developed relationships with the city, county, within different regions. Some places had, for instance, hotels that we could ultimately put a homeless patient in. We had the ability to monitor them while they had COVID and then keep them isolated as well.”

As the public emergency continues, Thury believes that health systems should strongly consider implementing a program that allows them to provide care in the home.

“For places that aren’t doing something like this — I think it is greatly beneficial,” he said. “I get emails or messages almost every day from patients that we care for, and they are just amazed at the service and are just so happy that they were able to stay home.”

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