Patients embrace hospital at home programs

Hospital-level healthcare is knocking at the front door, and patients are increasingly willing to welcome it into their homes. As Congress debates the future of the popular pandemic-era Acute Care Hospital at Home program for Medicare, patients are widely signaling their approval of such initiatives, which could help tip the scales in favor of extending and expanding the model for at least the next few years. 

In addition to a recent industry survey showing that 84% of patients would be willing to get care at home if it meant an earlier discharge from the hospital, new research published in JAMA shows widespread confidence in the safety and convenience of home-based, hospital-level care.  

Researchers from the Schaeffer Center at the University of Southern California conducted the poll of more than 1100 people, including younger, healthier populations, in the second half 2023. They found that nearly half of respondents (47.2%) actively approved of the notion of home hospital care, while a further 36.2% were neutral on the subject. Only 16.6% thought the idea was “unacceptable.”  

Most agreed (55.8%) that people recover faster at home than in the hospital, which tracks with the earlier survey in which patients prioritized being in the comfort of their own homes rather than the hospital setting, which can be noisy, disruptive, and disorienting. 

Respondents also expressed high confidence in the safety of hospital at home care, which typically includes a suite of personalized remote monitoring devices in addition to in-person visits from clinicians. Close to 60% said they agreed or strongly agreed that they would feel safe being treated at home, the survey found. Just 10% expressed a decidedly negative opinion on the safety of at-home care.  

Convenience was also a plus from the patient perspective. Similar numbers said they would likely feel more comfortable being at home in familiar surroundings without the need for friends and family to travel for visits or to provide advocacy support.  

“Patients of course want the best-quality care, but often prefer to be at home, especially if technology allows them to work closely with their physician team toward recovery,” said Melissa A. Frasco, research scientist at the Schaeffer Center. 

Overall, 47% would voluntarily choose to be treated at home if they had the option – although they are less certain about how much they would be willing or able to take on if it was a close family member or friend who was receiving at-home services instead. 

Capacity and willingness to be a caregiver varied among the participants, and depended greatly on the tasks they’d be comfortable taking on. For example, while 82.2% agreed they would be willing to help manage the medications of an at-home patient, just 67% said they would assist with wound care and only 41% said they would change a feeding tube. 

This indicates that hospital-at-home programs can’t rely wholly on remote monitoring technologies and the good will of cohabitants in the home. Instead, they must appropriately integrate home health clinicians who can perform tasks that may be too much for caregivers.  

Accessible and reliable home visits will be especially important in situations where patients are experiencing social isolation or when the other members of the family do not have the functional ability or health literacy to complete necessary tasks in a safe and effective manner. 

“Our findings offer valuable information for policymakers and health systems as they navigate a new landscape of post-pandemic patient care,” says co-author Erin L. Duffy, director of research training at the Schaeffer Center. “Extending reimbursement for hospital-at-home care could go a long way toward reducing costs and improving outcomes, benefiting all parties involved.” 

While the Medicare version of the hospital at home program has received bipartisan support, it’s unclear whether Congress will renew the model before its expiration date at the end of 2024.   

Developing a program in an uncertain reimbursement environment can be challenging, but that hasn’t stopped hundreds of health systems from offering advanced, technology-driven options for home care that seem to have positive results in terms of costs and outcomes. 

As patient support for at-home care continues to build, it’s likely that health systems will continue to advocate for reimbursement mechanisms that make similar initiatives a possibility, especially as an aging population demands more in terms of convenience and personalization. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.