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Hospital at Home Through the Patient’s Lens
Updated: Sep 19
How could a patient NOT want high acuity hospital quality care at home instead of in the traditional bricks and mortar setting?
While most patients rave when discharged from the hospital, the move home – untethered from the care and technology of a hospital ward – can still be anxiety-inducing for them, their families, and even their physicians. But as improved Hospital at Home (H@H) outcomes increase, this fear is becoming proportionately reduced.
So what do patients say about H@H?
First a clarification: H@H is not 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 needing sophisticated hospital-level care in the home setting. Their responses underscore why we should not underestimate the emotional and technological subtleties of this elevated care.
Sleep
Without exception, H@H patients describe how they often get more sleep at home instead of in the bricks-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 our vitals taken or receive sleeping pills.
If not woken up by a well-meaning clinician, the dozens of alarms going off 24/7 in the typical hospital are something patients rarely get desensitized to. Personal experience tells me that these alarms increase worry, even if unrelated to you.
Simply put: H@H patients get more rest, which increases the likelihood of better outcomes.
Food
Even if the food at home is not at an elevated culinary experience, chances are it’s tastier than the food served on hospital cafeteria trays. Though many patients have dietary restrictions that a hospital nutritionist is accustomed to tailoring, new vendors can meet those same needs and send customizable meals to patients’ homes.
In addition, H@H patients with mobility can cook for themselves, which in and of itself is therapeutic (especially for the foodies)!
Companionship
Hospitals regularly bring in dogs and cats for patient emotional support during extended stays. The fact that H@H patients can have their pets near them or (with approval) in the same bed or couch impacts the battle against loneliness and depression.
More noticeable is the fact that family and friends do not need to coordinate visits but can walk across the house or apartment to see their loved ones when needed most.
In the spirit of full disclosure, this can be a mixed blessing.
Many family caretakers are more obsessive about their patients than professionals. And patients often report needing an adaptation period for the family, considering that this is not just home but hospital in the home care.
In addition, H@H reimbursement requires frequent home visits by physicians and other healthcare specialists, so this involves new forms of companionship between both the patient and the professionals and 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 show, 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 even though the patient is no longer getting high acuity care in a traditional hospital.
Sanitization
One of the most consistent research findings is that H@H patients have a much lower incidence of hospital-acquired infections. One might say this is obvious since there is no longer a hospital for them to get infected in. However, patients report fewer infections in general, reducing the anxiety of getting “sicker because of the hospital” or being readmitted to the hospital due to complications.
Outcomes
Patients are hearing about how H@H is showing empirical evidence of improved outcomes. Payors are hearing the same thing and are increasingly embracing H@H reimbursements. Most importantly, 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 typically increase the cost of care and thus go counter to value-based care.
For more on the latest trends in H@H, watch the on-demand video proceedings of the H@H Leadership Conference.
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