Hospital-at-Home Advocates Believe the Model Can Stave Off Staffing Burnout

Advocates of the hospital-at-home model are continuing to make a strong push for the extension of the Acute Hospital Care at Home waiver.

Specifically, hospitals that have taken advantage of the waiver are saying it needs to stick around because it is actively driving both patient and provider satisfaction.

“One of the focuses of [the Mayo Clinic’s] 2030 plan is ‘the patient will see you now,’” Dr. Michael Maniaci, the medical director of the Mayo Clinic’s Advanced Care at Home program, said on a webinar hosted by the Advanced Care at Home Coalition and McDermott+Consulting last week. “This is focused on individualized medical expertise at the patient’s convenience – not at the institution’s convenience. We’ve tried to flip the script with this, just like Amazon does for shopping or GrubHub does for food and groceries, bringing the product to the customer in their home is what we want for health care.”


As of June 8, 105 health systems and 239 hospitals in 36 states has been approved to provide hospital-level care at home through the the waiver, according to the U.S. Centers for Medicare & Medicaid Services (CMS).

The waiver, however, is set to expire with the public health emergency (PHE). That’s why the “Hospital Inpatient Services Modernization Act” was introduced in March. It would extend for the waiver by two years after the expiration of the PHE, and also require CMS to establish regulations regarding health and safety requirements for the program within a year of the bill’s enactment.

The bill is sponsored by Sens. Tom Carper (D-Del.) and Tim Scott (R-S.C.), as well as Reps. Brad Wenstrup (R-Ohio) and Earl Blumenauer (D-Ore.). The latter two also contributed to the webinar.


“To get to the future we need to move past today by extending the waiver we were granted during the public health emergency,” Maniaci continued. “By extending the waiver, we will continue to care for our sickest patients wherever they may be. And we will continue to collect vital data on the hospital-without-walls effort.”

Patient and provider satisfaction

The waiver was initially for hospitals and health systems to create more capacity during COVID-19 spikes over the last two-plus years.

Since then, it has been touted as the future of care for patients.

“About a quarter of our patients have Medicaid and about a quarter of our patients are dual-eligible,” Constantinos Michaelidis, the medical director of UMass Memorial Health’s hospital-at-home program, said on the webinar. “And so these are typically the most disadvantaged, often with the largest socioeconomic challenges. And they often have a lot of distrust of the existing health care system. And so by being in their home during this period of time, in our hospital-at-home program, we have several advantages.”

Those advantages, according to Michaelidis, include a greater comfortability for patients, a better understanding of their social challenges and a better scope of their total health care picture – which can be addressed in the home.

But perhaps a less expected development from the hospital-at-home wave has been the effect its had on staff.

“There have been a number of folks who have come to us and said, ‘You know, I actually was going to leave the profession because I was too burnt out, but I feel like I’ve had a rejuvenation by coming to our home hospital program,’” Michaelidis said.

Mae Centeno, the chief nursing officer of virtual care delivery at Texas Health Resources, reiterated that sentiment.

“Nursing is a physically, emotionally and mentally taxing job,” she said. “And so there are several nurses who are not yet quite ready to retire, but are thinking they want to retire because of the current environment, and just what they’ve experienced the last two years. Then on the other hand, we also have nurses who love nursing and don’t want to wait until they’re burnt out, but they want to have another avenue to be able to use their skill set. So this was such a welcome change for them.”

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