Wayne Whitehouse knew he wasn’t feeling well, having had similar symptoms before. He went to the ER, had some tests, received IV antibiotics and opted to go home rather than be admitted to the hospital while awaiting results.
The next morning, tests revealed an infection, causing the hospital to summon him for in-patient care.
“The hospital was way packed, and a lot of people were waiting for a room. I came in around noon and got a room at 11 p.m.,” says Whitehouse, a retired warehouse manager from Lacey, Washington.
The next morning Whitehouse, 73, heard that he’d be a good candidate for Hospital at Home (HaH), a program that Providence St. Peter Hospital in Olympia had launched the previous year.
“I just felt I’d probably do better at home,” he says. “I thought it would be a good move and possibly open a bed at the hospital.”
His wife Karon, also 73, agreed. Four days into HaH, Whitehouse was “released,” but was already home.
The benefits of Hospital at Home
That November Hospital at Home stay wasn’t the home health care that many know. HaH is a specific designation for acute patients who need hospital-level care but who are considered stable enough to receive it at home. Either they went to an emergency room and were considered suitable for HaH, or, after being in the hospital, are released to continue HaH. It can last days, weeks or longer, depending upon treatment. A medical team (including doctors and nurses or EMTs) makes home and virtual visits.
Advocates warn that hospitals aren’t always the safest places for some patients — particularly older adults who may become confused by unfamiliar surroundings. Others cite hospital-acquired infections, as well as interrupted sleep, among other negatives associated with in-patient care for those with stable conditions. However, limited research on the health benefits and costs of HaH has left questions about its long-term rollout. HaH is not widespread. Whether it becomes so largely depends on what happens as the U.S. health care system evolves.
“There are some things you can’t do in the home. ICU care is not going to happen in the home. We’re not doing surgery in the home,” says Mark Howell, director of policy and patient safety for the American Hospital Association.
Among the challenges for hospitals are developing a new program under current workforce shortages while aiming to close gaps in health equity.
In addition to good connectivity for remote patient monitoring, certain basics, such as a home needing heat, electricity and running water, as well as factors such as distance from a hospital, are necessary ingredients. Serving a rural population or an area without broadband complicates the ability to provide virtual care, a keystone of the model. If an HaH patient doesn’t have Wi-Fi,hospitals provide a hotspot and a tablet to communicate.
A pandemic jump-start
Geriatrician Bruce Leff, a trailblazer and advocate for HaH, has long said he believes most care in the future will be at home, with hospitals offering only emergency rooms, intensive care units and operating rooms. Leff started this work in 1995, later developing an HaH program. His early published studies — in 1999 and 2005 — show the model as “feasible, safe and efficacious.”
Not until “the pandemic unlocked everything” did HaH start to grow, he says.