| When Debbie Farley and her husband, Bob, developed flu-like symptoms in February, they initially thought little of it. Coronavirus hadn't spread to their community in Topeka, Kansas, at least as far as they knew. But after a month, they weren't getting much better. Bob, a 73-year-old Vietnam veteran, was admitted to the hospital and diagnosed with double pneumonia.
The next day, he tested positive for COVID-19. He was moved to the intensive care unit and spent 12 days in the hospital while Debbie quarantined at home.
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After nearly two weeks apart, Debbie didn't want Bob to follow the standard protocol of being discharged from the hospital into the COVID-19 ward of a nursing home or rehab facility, where he would continue to receive treatment but where she couldn't visit him. “I talked to the doctor and told him I wanted him home,” she says. “I wanted him here to take care of him."
The coronavirus pandemic has made nursing homes and the rehab centers that are attached to many of them less desirable places to recover after hospitalizations. For the Farleys, it was limited visitation options. For others — including the hundreds of thousands of older Americans mulling or scheduling hip and knee replacements and other surgeries — it's fear of contracting COVID, which has claimed the lives of over 80,000 long-term care residents and staff, according to the Kaiser Family Foundation.
"People want more than ever now to stay out of the nursing home,” says Rachel Werner, M.D., executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. “The dangers and potential downsides have really been laid out to public viewing."
The result is that at-home recoveries appear to be booming. Hospital discharge data analyzed by the Avalere Health consulting firm showed overall inpatient hospital discharges were down 12.7 percent in June from a year prior, as many patients postponed elective procedures. But discharges to home health services were up 4.6 percent, while discharges to skilled nursing facilities were down more than 25 percent.
The Farleys opted for at-home rehab through a company called Interim HealthCare. Bob's periodic video calls with doctors, his oxygen-monitoring equipment and in-person nursing visits were covered by Debbie's health insurance. “We only had one person coming in — we may have all had masks on, but at least he wasn't exposed to 20 different people,” she says, referring to the threat from the coronavirus.
Telehealth policies have loosened since the pandemic began, helping feed the surge in at-home recoveries. Medicare has relaxed guidelines for the kinds of patients eligible for services that make rehab at home possible, and many insurance plans now cover those services.