Hospital-at-home through a patient lens

How could a patient not want to have high acuity, hospital quality care at home as opposed to in the traditional brick-and-mortar setting? 

Well not surprisingly, most patients rave over being discharged from the hospital and being admitted to the home setting. However, some patients, families, and in fact physicians are somewhat anxious about the move. Many of these patient concerns are related to the feeling of being untethered from the care and technology in a hospital ward. But as improved hospital-at-home (H@H) outcomes increase, patient and clinician fear has been proportionately reduced.

Most of the luminaries will take great pains to reinforce that H@H is not at all the same as “home care” where the patient has recovered but still needs the safety net of a caretaker at home.  

 Therefore, I focused on patients who truly needed sophisticated hospital-level care in the home setting. As you can imagine the emotional and technological subtleties of that elevated care can not be underestimated.  

So what do patients say?  

Sleep  

Without exception, H@H patients describe how they were able to get much more sleep and rest at home as opposed to in the brick-and-mortar setting. Many of us who have been hospitalized have experienced the frustration of being woken in the middle of the night to have vitals taken or to be given a sleeping pill.  

If not woken up by a well-meaning clinician, the dozens of alarms going off 24/7 in the typical hospital are not something the patient ever gets desensitized to. Personal patient experience tells me that these alarms increase worry, even if they are not related to you.  

Simply stated H@H patients get more sleep and rest which increases the likelihood of better outcomes.    

Food  

Even if the food at home is not at an elevated culinary level, chances are it’s tastier than the food served on cafeteria trays in the hospital. Granted many patients have dietary restrictions that a hospital dietitian is equipped to tailor, but that customization is now being offered by companies that deliver the nutritional elements and restrictions that patients require, without them staying in a hospital.  

In addition, H@H patients who have mobility can actually cook for themselves which in and of itself is therapeutic, especially for the foodie!   

Companionship

Hospitals regularly bring in dogs and cats for patient emotional support during long stays. The fact that H@H patients can have their pets near them, or with approval actually in the same bed or couch has a huge impact on battling loneliness and depression. 

More obvious is the fact that family and friends do not need to coordinate visits in social distance-sensitive brick-and-mortar hospitals but can walk across the house or apartment and see their loved one when needed the most.   

In the spirit of full disclosure, this can be a mixed blessing. Many family caretakers are more obsessive about the patients than others. In many cases, patients report that there needs to be an adaptation period for the family considering that this is not just home care….it’s a hospital in the home. In addition, H@H reimbursement requires frequent home visits by physicians and other healthcare specialists, so this requires a new form of companionship not only between the patient and the professionals but also between the family and those professionals in the home.  

Environmental

To oversimplify, patients want to be cared for at home because it’s home!  

Patients love looking out their window, sitting on the porch, using their own bathroom and shower, adjusting their lighting, listening to music without disturbing a roommate, having all the channels they love on the TV, and knowing that a family member isn’t treating another patient when needed the most.   

It is important to note that H@H strategies still require the patient to be tethered to an external support system. This is done through sophisticated command centers that monitor the patient 24/7 from whatever distance. So in reality the environment becomes distributed despite the fact that the patient is no longer getting high acuity care in a traditional hospital.    

Sanitization 

Perhaps one of the most consistent research findings is that H@H patients have a much lower incidence of hospital acquired infections. Now one might say that this is obvious since there is no longer a hospital for them to get infected in. However patients find that they get fewer infections of any kind in the home, in addition to the anxiety of getting “sicker because of the hospital” is greatly reduced.  

This has a profound effect on reducing patient fears that they will be readmitted to the hospital and that their recovery period will be shorter.  

Hospital-at-home: The intersection of outcomes & reimbursement

Patients are hearing about how H@H is showing empirical evidence of improved outcomes and much fewer readmissions. Payors are hearing the same thing and are increasingly embracing hospital-at-home reimbursements. Most important is that the federal government has extended the Omnibus bill to provide a waiver on H@H funding simply because patients are getting well more quickly and with less risk which would normally increase the cost of care and thus go counter to value-based care.  The hopes are that the waiver will be made permanent at the end of 2024 so reimbursements and investments inH@H will accelerate.   

Keep an eye out for more in the Digital Health Insights H@H Technology Series and digital events.