DES PERES — While Marie Alexander was battling a serious infection, her “hospital room†was at her daughter’s home in Des Peres, where she was waited on by her grandchildren and snuggled with the family dog at night.
Alexander, 75, was given an oxygen machine and intravenous medications to treat the infection. A doctor came by once a day, and nurses twice. She used an iPad to connect to providers virtually if she needed.
“I was mostly on the couch, surrounded by toys and the TV and the children,†she said. “It was a very loving atmosphere, calm and peaceful.â€
Alexander was among the first patients who chose to participate in
Mercy Hospital ºüÀêÊÓƵ’ new hospital-at-home program — a growing model across the nation and the first for the ºüÀêÊÓƵ region — that started in September.
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The program allows for some acutely ill patients who live within a 25-minute drive of the hospital to receive care in their homes. They are sent home with monitoring equipment, medications and a number to call anytime for help. Mobile X-ray and imaging services and therapists can be dispatched when needed.
Candidates include patients with conditions such as pneumonia, congestive heart failure, chronic obstructive pulmonary disease or cellulitis.
Patients are offered the option of receiving care at home either after first spending a couple days in the hospital or after coming to the emergency department. Most are looking at about a four-day hospital stay.
“What we like to say is we discharge you from your couch back to your couch,†said , Mercy’s regional director for the program.
Hospital-at-home care is currently only covered for Medicare patients, but hospital officials hope that soon other insurance companies will follow suit. A growing body of research shows it can reduce costs while improving outcomes. And patients and their families like it.
“I thought this feels like VIP service when the doctors who we were just talking with in the hospital are now in my living room,†said Alexander’s daughter, Becky Rhoads.
Rhoads, 45, has two busy children, ages 9 and 11, and her husband travels often. “The whole thing was much easier than coordinating with my sisters on who’s going to be at the hospital, when can you be there and who is going to take the kids,†she said.
Ursula Wright, Mercy’s chief clinical excellence officer and nurse, said hospitals are trying to be more creative in meeting patients’ changing needs.
“When someone is in the hospital, it can be difficult for them, and it creates challenges for their loved ones in a variety of ways,†Wright said. “Mercy Hospital at Home will reduce those burdens and provide the same high-quality care they expect from Mercy in their own environment where they feel most comfortable and can heal most easily.â€
Response to pandemic
Baltimore’s Johns Hopkins Medicine has operated a hospital-at-home program since 1994 and led the way in in the United States.
Johns Hopkins developed its program mainly for elderly patients who were at risk of falls, hospital-acquired infections, delirium and poor sleep inside hospital walls. Early studies showed the cost was 32% less than traditional hospital care, hospital stays were shorter by one-third and the incidence of delirium and other complications was dramatically lower.
The model was adopted by some Department of Veterans Affairs facilities, as well as New Mexico’s Presbyterian Healthcare Services and Mount Sinai in New York.
showed the model resulted in 25% lower cost and a 20% reduction in deaths. Patients were also three times less likely to be readmitted to the hospital within 30 days of being discharged.
Despite the findings, skepticism that the quality of care was better than in a hospital prevented the model from being largely adopted. Commercial and government insurance and government programs would not cover it.
Then the COVID-19 pandemic hit.
In response, the Centers for Medicare and Medicaid Services (CMS) eased rules and allowed hospitals to apply for a waiver to offer in-patient care in other settings, including homes, and reimbursed the cost. Congress extended the waiver program through the end of 2024.
The pandemic expanded telehealth capabilities and resulted in patients becoming more reluctant to go to the hospital.
As of November, 305 hospitals in 37 states are approved for waivers, including four Saint Luke’s Health System hospitals in the Kansas City area, .
The model also helps hospitals address another result of the pandemic — staffing shortages that can cause long wait times for a hospital bed.
“We open up that bed capacity for someone that is more acutely ill, who is in the emergency room and needs to come upstairs,†Pickrell said. “We are improving hospital throughput and opening up capacity for all our patients to get the level of care that they deserve.â€
Providers are also able to connect to patients on a more personal level in their homes, he said, helping them overcome the burnout driving many away from their professions.
Pickrell said he expects Medicare coverage to continue after next year and for more insurance companies will come on board. “A lot of programs are proving it to be a viable health care model, that it’s safe for patients, the patient experience is better and patients do better,†he said.
Union nurses’ concerns
Some still have concerns about hospital-at-home programs. National Nurses United, the country’s largest union of registered nurses, calls the programs ““ and are an effort by the hospital industry to increase its profits at the expense of patient safety.
The nurses’ union a year ago condemning the CMS waiver and urging hospitals to instead invest in staffing and infrastructure needed to increase the capacity to care for acute patients.
Hospital-at-home programs cannot provide patients with the ongoing assessment, holistic treatment and rapid response by health care providers that is necessary for acute patient care, the union argues.
Qualifying patients could also live alone, without a caregiver at home.
“As a nurse who worked at the bedside for years, and knows how quickly things can turn south for a patient, I am deeply distressed by anyone pushing a scheme that replaces hands-on care by a trained nurse, who went through years of rigorous and science-based schooling, with a video camera and a remote call button,†said Michelle Mahon, NNU’s assistant director of nursing practice.
Mercy officials said a group of paramedics can be deployed immediately to a home should a patient need something immediately such as a new medication or IV replaced. Nurses also complete an extensive safety assessment of the home, review all medications and clearly outline any instructions. Specialists like cardiologists and endocrinologists are virtually on-hand around the clock.
“As far as Mercy is concerned, these literally are inpatients in hospitals, so we do not see them any differently than if they were admitted to a hospital bed,†said , medical director of transition care for Mercy. Administrators must follow and track all the same quality and measures.
Seeing patients at home actually helps providers better address their health challenges, such as fall hazards or access to healthy food, Mohart said. “It allows us to care for them on a much higher level when we can see and understand that, than if we never had that line of sight.â€
Alexander said she felt like the doctor and nurses who cared for her at home were thorough and observant of any changes. “They were looking at all the aspects, the whole person, not just reading the machines,†she said.
Alexander’s daughter said she felt more informed about her mother’s care because, in the hospital, she might miss the doctor stopping by. The hospital staff also offered to provide meals and even insisted on dropping off over-the-counter cold sore medicine.
“They made us feel comfortable that someone was always available,†Rhoads said. “We had that phone number to call that was just for the program.â€
‘You feel better’
Riley Williams Jr., 71, recently received inpatient care for a serious skin infection at his home in Breckenridge Hills he shares with his granddaughter. He also said he communicated more with his doctor and nurses while at home, where he had their undivided attention.
“They are not here for no five or 10 minutes neither,†Williams said. “One time, they even cooked me something to eat.â€
Because he is blind, he said, he can’t get out of bed while he is in the hospital. But at home, with a fanny pack-like portable IV, he was able spend time in his favorite computer room caring for his 20-or-so plants, playing music and listening to his audio books. And he didn’t have to wear a hospital gown.
“You feel better, and you sleep better than in those hospital beds,†Williams said. All he had to do was take his own temperature and blood pressure.
Marvell Adams Jr., CEO of Caregiver Action Network, the nation’s leading family caregiver advocacy organization, said choosing whether to receive care at home depends on the challenges and capabilities of each patient and caregiver.
“Each program has a level of stress that is going to be put on the caregiver, but in incredibly varied ways, and it depends on a number of unique factors that are really kind of hyper-specific to a caregiver,†Adams said, as well as what level of care is needed.
Adams suggested patients and caregivers have a full understanding of what they will be required to do so they can identify any problems that might pop up and how those would be addressed.
He also suggested asking about any possible costs that might not be covered in the home setting that patients could be stuck paying for.
“It’s just kind of weighing opportunities for success of someone being at home vs. being in the hospital,†Adams said. For more advice, the Caregiver Action Network provides a caregiver help line at 1-855-227-3640 and online chat at .
Mercy officials says they plan to expand the hospital-at-home program to Mercy Hospital South, the third largest hospital in the ºüÀêÊÓƵ area, within the next few months.
“Mercy more and more is going towards this model that I believe is the future of health care,†Mohart said, “which is that the home, the patient’s home, is their default place of care.â€