No one likes the idea of staying in the hospital. It can feel scary and lonely. Plus, you face exposure to germs and a lack of privacy. Fortunately, some patients can now get hospital care at home through hospital at home programs.

Before we dive into getting hospital-level care at home, it’s important to understand the different kinds of medical care you can get at home. Basically, there are four kinds of medical care you can receive at home:

1. Home health services for which a healthcare professional comes to your home to help you manage a chronic illness or injury.
2. Telemedicine appointments during which you see your healthcare providers via video calls.
3. Remote monitoring for chronic and acute conditions.
4. Hospital at home programs, run by hospitals, provide acute care for conditions that would traditionally require a stay in a hospital.

Read my previous blog, Can You Get Your Medical Care at Home for information on the first three types of healthcare services.

Getting hospital care at home.

Hospital at home* programs provide care for patients who require acute hospital-level care who traditionally would receive care as an inpatient in the hospital. For instance, people with complex diseases such as sepsis, pneumonia, and congenital heart disease, who just a few years ago required a hospital stay, can receive high-quality, acute care in the comfort of their own homes.

How do these programs work?

Importantly, a multidisciplinary team provides daily input into your care plan. You will receive daily in-person and/or virtual visits from medical staff, with an ability to respond to urgent needs. 

Additionally, you will receive 24/7 remote monitoring which sends real-time data to the hospital. This remote monitoring allows for convenient, continuous, and often passive monitoring of your health.

Depending on your needs, you may receive different types of devices, including weight scales, pulse oximeters, blood glucose meters, blood pressure monitors, and/or heart monitors. Importantly, each device sends data to your medical team – the same data that would be available if you were in the hospital.

As part of the program, you will receive hospital-level interventions at home as needed (e.g., intravenous fluids, medication therapy, x-rays, oxygen). And, these programs provide needed medical devices and equipment, such as hospital beds, infusion pumps, and ventilators.

Additionally, when necessary, many programs provide a hotspot and tablet for communication between you, your monitoring devices, and your healthcare providers. And depending on the program, you may receive services to make sure you have access to healthy food.

Importantly, patients participating in hospital at home programs are considered hospital patients. As such, hospital at home healthcare providers must follow a set of hospital rules.

*Note – these programs may also be called virtual hospital at home, acute care at home, home hospitalization, virtual ward, and early supported discharge. For ease of reading, I refer to these types of programs as “hospital at home” programs.

How common are hospital at home programs?

These programs are growing, particularly among large, crowded hospitals that run at or near capacity and therefore want to free up beds. For instance, in 2024, Mass General Brigham stated they want to move 10% of all its medical patients to the home.

On the other hand, hospitals with extra capacity, either due to newly built facilities, shrinking populations, or competition from other hospitals, are less likely to launch hospital at home programs.

Unsurprisingly, payment for services is also a consideration. The Covid-19 pandemic spurred hospital at home programs, with Medicare coverage of hospital at home services. Now, in 2024, legislation is in the works to help hospitals expand home services, with the hope that recovering at home will cost less than inpatient care.

Who receives care through hospital at home programs?

With hospital at home programs, patients who need hospital-level care but are deemed adequately stable can receive their care at home. This generally happens in one of two ways:

• During a visit to the emergency room, a doctor determines you need additional care, but you are well enough to receive the care at home.
• After a hospital stay, a doctor decides you are well enough for discharge, but you need to continue receiving treatment at home.

However, some programs allow patients to directly enter a hospital at home program based on referral from a treating primary care doctor or specialist.

Who cares for patients in hospital at home programs?

Doctors, nurses, paramedics, and/or EMTs make home and virtual visits.

How long can you receive medical care at home through a hospital at home program?

Importantly, your care under a hospital at home program can last days, weeks or longer, depending upon your situation. However, the average length of “stay” is four days.

What if you unexpectedly need more care?

In some cases, you may need to be transferred to a hospital for more thorough care or for in-hospital diagnostics (such as an MRI, CT scan, or endoscopy). In these situations, the program will transport you to and from the hospital as needed.

What about emergencies?

Importantly, realize that in emergency situations, you will not have the same access to immediate care that you would have if you were in the hospital. Instead, you (or your caregiver) may have to handle issues yourself while you wait for emergency help to arrive.

What are the benefits of hospital at home programs?

There are many advantages to hospital at home programs.

Importantly, a systematic review of studies conducted between 2005 – 2020 found that “for suitable patients, hospital at home generally results in similar or improved clinical outcomes compared with inpatient treatment”.

Additionally, hospital at home programs can provide the following benefits – as compared to patients treated while hospitalized:

• Reductions in mortality and healthcare-related complications.
• Reductions in unplanned hospital admissions, including for cancer patients.
• Improved functional outcomes.
• Reduction in delirium for patients with cognitive issues such as dementia.
• Increased physical activity levels, with less time sedentary or lying down, which can reduce the risk of pressure sores.
• Reduced healthcare use (lab tests, imaging, etc.).
• Fewer skilled nursing facility admissions and emergency department visits.
• More privacy.
• Reduced cost of care.
• Easier access to healthcare services, and improved engagement with healthcare, for underserved populations, including low-income and rural patients.
• Improved collaboration and shared decision-making between patients, families and healthcare providers to design and manage patient-centric, comprehensive care plans.

Additionally, it’s easy to see that getting medical care at home can reduce the risk of common hospital-related health issues, including exposure to germs, difficulty sleeping, medication errors, and patient identification errors.

Lastly, the programs free up hospital beds, including in the emergency room where patients can remain for hours or days waiting for a bed to open up.

What do patients and family caregivers think?

Research shows that hospital at home programs lead to increased satisfaction and reduced stress for patients and family caregivers. Conversely, being in your own environment makes you more comfortable, which contributes to healing.

Additionally, in a Medicare study on hospital at home programs, patients, family members, and caregivers were “overwhelmingly positive” about these programs. For example, the patients reported feeling more relaxed and less depressed in their homes, “which seemed to aid their recovery,”. And others said they appreciated tech-enabled communications with their healthcare teams. Lastly, respondents appreciated being more involved in the patient’s care.

The downsides of hospital at home programs.

Firstly, not all patients are good candidates for hospital at home programs. For instance, patients in crowded households may not have enough room for needed equipment or desired privacy.

And some patients may not have needed support from a family caregiver to help with activities of daily living. For example, some family caregivers cannot physically help their loved one get dressed and bathed, while others are not available due to job demands. Although these programs try to reduce the burden on family caregivers, it can certainly turn into a part-time or even full-time job.

Caregiver burdens.

Importantly, family caregivers have a lot of responsibilities when a loved one is in a hospital at home program. Educate yourself about what will be required. Ask as many questions as you need. And before agreeing to be a family caregiver, make sure you have the time, knowledge, strength, and stamina to handle everything required.

As a caregiver, you will likely have to perform a range of tasks, including help with toileting, dressing, and eating. Although the hospital at home program may include home health aides to help with daily living tasks, the help is usually for limited hours. If you plan on hiring a healthcare aide to help, make sure you leave yourself enough time to find and train an aide.

My personal experience.

My husband and I were family caregivers for our teenage son Zach during his battle with a terminal brain tumor. Although Zach was not enrolled in a formal hospital at home program, towards the end of his life, we were overwhelmed by our responsibilities caring for him at home.

For instance, we fed him through a nasogastric tube, gave him 4 injections each day, and managed over 20 medications. We also used a suction machine to remove saliva from the back of his mouth, and another machine to remove fluid from his lungs. Although we had a helpful aide, there was still so much for us to do.

However, I am very glad we had him at home instead of in the hospital, so for us, it was well worth it.

Quality of care concerns.

Firstly, when caring for a patient at home, medical staff don’t have the equipment and labs available in hospitals. For instance, it’s impossible to provide ICU-level care or perform surgical procedures in a patient’s home, even in emergency situations.

Secondly, some doctors, in both small and large hospital systems, worry about the technology aspects of hospital at home programs. Even with state-of-the-art tech, some doctors worry they won’t be able to examine patients as thoroughly — or at all — when care is remote.

Lastly, there are quality of data concerns related to the use of remote monitoring.

Importantly, ECRI, an independent nonprofit patient safety advocacy group, has concerns related to the safety and effectiveness of technology used in hospital at home programs. In fact, they consider the home use of medical devices the top health technology safety hazard for 2024.

Primarily, potential problems stem from the home use of technology and equipment designed for in-hospital use by trained healthcare professionals. The lack of training, combined with device complexity, makes it hard for laypeople to safely and effectively use the devices. Importantly, ECRI states that “severe harm can result from the misuse or malfunction of medical devices in the home”.

The home use of medical devices can lead to issues, including the following:

• Misinterpretation of device readings, which can lead to a false sense of security.
• Missing, or failing to report, error notifications.
• Medication errors when using infusion pumps.
• Skin injuries from incorrectly applying electrodes for a cardiac monitor.
• Patient death if a home ventilator alarm does not activate or if no one hears the alarm.
• Dislodging of a venous needle during the use of hemodialysis machine.

Additionally, if a device stops working at a hospital, an alarm sounds and a nurse or technician responds quickly to fix the issue and attend to the patient. But if a piece of equipment malfunctions at home, it could take hours for trained help to arrive, potentially putting the patient in danger.

Considering a hospital at home program for yourself or a loved one?

Before agreeing to a program, ask these questions suggested by AARP and Next Avenue:

• Which medical providers will come to our home? How often? Will some visits be virtual?
• If we need unexpected help, how quickly will a medical professional respond? What about emergencies? Will help be virtual or in person?
• Who will coordinate care? Who is responsible for day-to-day monitoring of the patient’s condition?
• Who will oversee the patient data sent from remote monitoring devices?
• How will we get medications needed for the hospital at home care? Will medications come in a timely manner? If help is needed to take medications, who will help?
• Who will help us get and set up equipment and devices needed? Will we receive training for needed equipment or devices?
• How much space is needed for equipment and supplies required to manage care at home. Will items be delivered in bulk? How often?
• How will we get the supplies needed for care? Will they be delivered to our home, or do we need to find and purchase supplies?
• If additional care is needed after the end of hospital at home care, how and where will the care be provided? Who will coordinate ongoing care after hospital at home care, and for how long?

Questions for family caregivers to ask:

• What tasks will I need to do as a family caregiver? How can I get help if the patient’s condition changes outside of the regular scheduled care visits? What about the availability of help after hours?
• If the patient will need assistance with daily living tasks, such as bathing, dressing, toileting, changing the sheets, and getting meals, am I responsible as caregiver? Does the program have home health or personal care services available for this type of help?

Learn more…

Managing any kind of serious health condition can feel overwhelming.

• Tips for Coping with a Serious Diagnosis.
• Tips and Strategies for Coming Home from the Hospital.
• 10 Tips for a Better Medical Appointment.
• Majority of Patients Don’t Understand Discharge Instructions.
• How To Care for Someone Who Is Bedridden at Home.