More hospitals are training their emergency room staff in geriatric care and building geriatric ERs. At the same time, hospitals are increasingly finding ways to provide the kind of inpatient care available in hospital at patients’ homes after an emergency. Essentially, they are bringing the hospital to people’s homes, with support from the Centers for Medicare and Medicaid Services and private foundations.
The “hospital at home” model relies heavily on technology that once was only available in hospital. Today, testing technology can be transported to people’s homes. In addition, body sensors can track people’s vital signs and transmit their data to doctors at the hospital. And video technology allows patients to have ongoing visual communication with hospital staff from the comfort of their homes.
Avoiding a hospital stay can improve people’s health outcomes. The risk of infection from antibiotic-resistant bacteria in hospital can be high. It is also risky to be in a facility filled with sick people who may be contagious. The likelihood of delirium for older patients in hospital is also very high, as they are out of their normal surroundings. My 95-year old father, a former physician, who is otherwise of sound mind, spent one night in a hospital ER and told me the following morning that he could not understand why staff had made him chief of pediatrics.
Michelle Andrews reports for Kaiser Health News, that Brigham and Women’s Faulkner hospital has established a hospital at home program for patients in stable condition. As an alternative to inpatient care, the hospital transports patients home, where a doctor and nurse are waiting for them. They check the patients’ IVs and affix sensors to the patients’ body. They can tell whether patients sleep well or are up in the middle of the night. And, they can tell when patients no longer need medical oversight.
The Johns Hopkins Schools of Medicine and Public Health have also developed a hospital at home model for qualified patients with particular conditions to check into their own bed for their hospital care. In this hospital at home model, patients with certain types of pneumonia, congestive heart failure, chronic obstructive pulmonary disease and cellulitis, who would otherwise have to be hospitalized for treatment may never go to the emergency room. Doctors and nurses provide both diagnostic tests and treatment therapies to patients at home. It is intended to address the risks of treating acutely ill older adults in hospital, where they all too often experience adverse events, such as hospital-acquired infections, as a result of compromised immune systems.
People in Australia, England and Canada have been benefiting from hospital at home programs for quite some time. But, in the US, insurers apparently have not come up with a model to pay for the services or a new definition of what it means for a patient to be “hospitalized.”
One small study found far lower costs for patients who participate in a hospital at home program than patients who are admitted to hospital, with no negative outcomes and similar patient satisfaction. Another study found that hospital readmission rates for hospital at home patients were about half as high as for hospital inpatients. Hospital at home care also makes it easier for family caregivers, who do not need to travel to the hospital to be with the people they love. But, insurers appear to be unwilling to innovate on this front. Right now, the hospital at home program is supported by foundation grants and the federal government.
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