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  • Cameron Oglesby

Now hospitals are starting to make house calls

Updated: Nov 14, 2021

This past August, I wrote about how COVID workarounds like remote working, telemedicine, and online grocery shopping and other services would continue to improve seniors’ lives long after the pandemic ended. Back then, I never realized that post-acute hospital care at home would be another.

But it is.

It’s not yet available in Richmond, or even Virginia. But Johns Hopkins University’s had a hospital at home (HaH) model since 1994. The Mayo Clinic is pilot-testing HaH. Some Veterans Administration medical centers have implemented it, as have Presbyterian Healthcare Systems in Albuquerque, Tufts Medical Center in Boston, Adventist Health Partners in southern California, and hospitals in Australia, Canada, England and Israel.

Specifics vary from one model to the next, but here’s how HaH works overall:

  • Part of the patient’s home gets turned into a hospital room, complete with hospital bed, IV stand, telemonitoring equipment and audiovisual conferencing setup. There’s also provision for mobile x-ray and lab tests.

  • Nurses visit to administer antibiotics and other medications according to schedule.

  • Physical therapists also visit to assist with rehab.

  • With the older Johns Hopkins model, physicians and nurses visit daily. Newer HaH models use telemedicine and remote monitoring to let doctors and nurses check in on patients and talk with them 24/7, no waiting.

For hospitals, doctors, and patients recuperating from surgeries or with chronic obstructive pulmonary disease (COPD), congestive heart failure, deep vein thrombosis, asthma, community-acquired pneumonia, urinary tract infections, and cellulitis, HaH is a win-win-win.

It’s a win for hospitals because shorter lengths of stay (3.2 vs. 4.9 days) reduce inpatient census, which in turn can increase surge capacity for outbreaks like the current pandemic.

It’s a win for doctors because, as the Mayo Clinic Health System’s Dr. Margaret Paulson says, “[W]e can essentially be at the patient’s bedside twenty-four hours a day, seven days a week…When I’m rounding in a brick-and-mortar hospital, I can’t tell you the number of times they’ve said to me, ‘Gosh, can you come back in an hour? My family’s coming then.’”

But it’s the patients themselves, and their families, who are the biggest winners of all. To begin with, studies have shown that HaH cuts the average cost of hospital care by almost $2,000. By shortening acute-care length of stay, it reduces exposure to hospital infections.

While in-hospital care is procedure-driven, HaH is patient-driven – something we at Senior Insights strongly believe in. Patients prefer being in their own home, in human contact with members of their family. They also appreciate the substantially easier access to their doctors, independent of any hospital schedules. “When the patient and the family have questions or concerns,” says Dr. Paulson, “they can just push a button, and we’re there.”

Although quality of care is comparable to in-hospital care, patients do much better at home. They’re less likely to experience delirium, health complications and readmissions. They also get more exercise and more sleep. And while hospital patients’ ability to perform activities of daily living (ADLs) declines during their stay, HaH patient’s functionality improves. They have fewer health complications and are significantly less likely to need readmission during the first three months after discharge.

No wonder they’re so much happier with it. In a recent Johns Hopkins study, nearly three-quarters of patients surveyed (72.3%) said they’d choose HaH if it were available. More than three-quarters (78.5%) said it would be more comfortable, 71.8% that it would be less of a burden on their family, and 62.5% that it would be less likely to result in infection.

Of course, there are some things that hospitals provide that HaH can’t – meals, housekeeping, help with bathing, dressing and other ADLs. But that’s where we can help.

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