Mass General Brigham’s Home Hospital, in collaboration with the New England Center and Home for Veterans (NECHV), has launched a groundbreaking home hospital program for veterans experiencing homelessness.

This initiative is the first in the country, allowing veterans to receive acute medical treatment in the comfort of a housing partner’s residence instead of a traditional health care facility.

Boston’s Mass General Brigham (MGB) Home Hospital program provides hospital-level care from trusted providers to eligible patients in the comfort of their own homes.

Through this program, eligible residents of NECHV’s Department of Veterans Affairs Safe Haven programhave access to hospital-level care from trusted providers in their Safe Haven residence. Safe Haven offers on-site support services for veterans with chronic medical or behavioral health conditions.

“The reason we decided to participate in this initiative is because, at times, we do have veterans who need to be inpatient, but they don’t want to be, and they often leave the hospital against medical advice,” Lena Asmar, vice president of Human Services, NECHV told Home Health Care News. “Their clinical outcomes end up being worse because they go back into the hospital and back and forth. We hope this is a way to stabilize and help support veterans with some acute conditions that can be treated in a home setting.”

Veterans at Safe Haven tend to have had longer lengths of homelessness. This includes street homelessness. They often struggle with substance abuse disorder or acute mental health disorders, according to Asmar.

“Experiencing homelessness has traditionally excluded individuals from our program and most hospital-at-home initiatives,” Dr. David Levine, clinical director for research and development at Mass General Brigham Healthcare, told HHCN. “This is an opportunity to change that. The goal is to intervene during a critical time in a patient’s life when they are both homeless and acutely ill. Many of these individuals get caught in a cycle where illness leads to the loss of their belongings or their place in semi-permanent housing. They also lose access to case management resources. When they are hospitalized, all of this is put on hold, and often, upon discharge, they find themselves back on the streets, having to start all over again.”

This pathway could significantly improve acute care for homeless patients, according to Levine.

“We have a significant homeless veteran population in Boston,” paramedic Charlene Van Ott told HHCN. “Many of them avoid seeking care because they worry that if they are hospitalized, they will lose their bed in a shelter or transitional program, which discourages them from getting the treatment they need. Additionally, hospitals can be very busy and loud. For some veterans, the noise and the large number of people moving around can be overwhelming, causing them to avoid the care they require.”

Individuals experiencing homelessness have significantly higher rates of health conditions, including diabetes, heart disease and HIV/AIDS. These rates can be three to six times higher than that of the general population.

Through the MGB Home Hospital program, patients receive comprehensive treatment, including at least two daily in-home visits from a paramedic or nurse and at least one daily virtual or in-person visit from a physician or advanced practice provider.

Patients benefit from a 24/7 remote monitoring platform that tracks vital signs and enables continuous communication with their clinical team. This comprehensive approach ensures that patients receive the care they need when needed. It has been shown to reduce hospital readmissions and improve physical activity.

When partnered with NECHV, veterans receive an extra layer of services.

“The Safe Haven program provides an enhanced level of resources for veterans, offering a comprehensive range of services such as primary care, psychiatric care, behavioral health support and housing assistance. The program is flexible and innovative, which facilitated our partnership. Both organizations are eager to pursue more innovative initiatives,” Levine said.

While the MGB team ensures that a patient’s medical issues are appropriately addressed, NECHV provides housing and additional support. This symbiotic relationship guarantees that none of the veteran’s services will be interrupted during their hospitalization at the center.

“The home hospital care model provides an opportunity to promote health equity. By delivering high-quality care directly to veterans experiencing homelessness — a historically marginalized group facing significant barrier s— we can ensure they receive the necessary care and support. This approach can ultimately transform their health outcomes and improve access to care,” Levine said.

Although data on the program’s effectiveness has yet to be collected, the study structure is currently being implemented.

“We are fortunate to have received a small grant to study and evaluate this initial effort,” Levine said. “We will conduct semi-structured qualitative interviews with patients, staff at the Center, and MGB personnel to understand their experiences with the pathway, identify necessary improvements and explore potential expansion opportunities. We will assess the outcomes of these evaluations and make any necessary adjustments.”

The potential for expansion and new partnerships exists, according to Levine, who also encourages other home hospital programs to follow the example. Van Ott shares this hope.

“This pathway will be crucial in transforming veteran health care,” Van Ott said. “It allows us to serve a historically underrepresented patient population by providing care where and when they need it, focusing on the specific health care needs of veterans – which is invaluable.”