What if you could go to the hospital… home?
Hospital home care is an increasingly common and often safer option for older people. But the future of the approach depends on federal action.
At the end of last month, 83-year-old Raymond Johnson began to feel short of breath. "It was hard to get around," he recently recalled over the phone from his apartment in Boston's Jamaica Plain neighborhood. "I could barely walk up and down the stairs without getting tired."
Like many older people, Mr. Johnson suffers from a variety of chronic health conditions: arthritis, diabetes , high blood pressure, asthma, heart failure and cardiac arrhythmia known as atrial fibrillation.
Her doctor ordered a chest x-ray and , when she showed Mr Johnson accumulating fluid, told him to head to the emergency room at Faulkner Hospital, part of the Mass General Brigham Health System.
M. Johnson spent four days as an inpatient being treated for heart failure and an asthma exacerbation: one day in a hospital room and three in his own apartment, receiving hospital care through a growing alternative popular – but possibly endangered – Medicare calls Acute Hospital Home Care.
The eight-year home hospital program run by Brigham and Women's Hospital , to which the Faulkner Hospital belongs, is one of the largest and largest care centers in the country. 600 people last year; it will add more patients this year and is expanding to include several hospitals in and around Boston.
"Americans have been trained for 100 years to believe that the hospital is the best place to be, the safest place," said the program's medical director, Dr. David M. Levine. "But we have strong evidence that outcomes are actually better at home."
Some of these programs started 30 years ago, and the Veterans Health Administration adopted them over a decade ago. home hospital stagnated, largely because Medicare wouldn't reimburse hospitals. Then, in 2020, Covid-19 brought about significant changes.
Hospitals being suddenly overwhelmed, "they needed beds," said Ab Brody, professor of geriatric nursing at New York University and author of a recent editorial on hospital home care in the Journal of the American Geriatrics Society. "And they needed a safe place for the elderly, who were especially at risk."
In November 2020, Medicare officials announced that while As the federally declared public health emergency continues, hospitals may request a waiver of certain reimbursement requirements, including for 24/7 on-site nursing care. Hospitals whose requests have been approved would receive the same payment for hospital care at home as for hospital care.
Since then, Medicare has granted waivers to 256 hospitals in 37 states, including the Mount Sinai in New York and the Baylor Scott and White Medical Center in Temple, Texas. Initially, hospital-at-home programs primarily treated common acute illnesses such as pneumonia, urinary tract infections, and heart failure; more recently they have also begun to deal with liver disease treatments, post-surgical care and aspects of cancer care.
Uncertainty as to the future involvement of Medicare prevents wider adoption of the approach. “If this were to become permanent, you would see at least a thousand hospitals in the next few years” adopt hospital home care, said Dr. Bruce Leff, a geriatrician at Johns Hopkins University School of Medicine who started one of these treatments. programs.
Hospital home care is an increasingly common and often safer option for older people. But the future of the approach depends on federal action.
At the end of last month, 83-year-old Raymond Johnson began to feel short of breath. "It was hard to get around," he recently recalled over the phone from his apartment in Boston's Jamaica Plain neighborhood. "I could barely walk up and down the stairs without getting tired."
Like many older people, Mr. Johnson suffers from a variety of chronic health conditions: arthritis, diabetes , high blood pressure, asthma, heart failure and cardiac arrhythmia known as atrial fibrillation.
Her doctor ordered a chest x-ray and , when she showed Mr Johnson accumulating fluid, told him to head to the emergency room at Faulkner Hospital, part of the Mass General Brigham Health System.
M. Johnson spent four days as an inpatient being treated for heart failure and an asthma exacerbation: one day in a hospital room and three in his own apartment, receiving hospital care through a growing alternative popular – but possibly endangered – Medicare calls Acute Hospital Home Care.
The eight-year home hospital program run by Brigham and Women's Hospital , to which the Faulkner Hospital belongs, is one of the largest and largest care centers in the country. 600 people last year; it will add more patients this year and is expanding to include several hospitals in and around Boston.
"Americans have been trained for 100 years to believe that the hospital is the best place to be, the safest place," said the program's medical director, Dr. David M. Levine. "But we have strong evidence that outcomes are actually better at home."
Some of these programs started 30 years ago, and the Veterans Health Administration adopted them over a decade ago. home hospital stagnated, largely because Medicare wouldn't reimburse hospitals. Then, in 2020, Covid-19 brought about significant changes.
Hospitals being suddenly overwhelmed, "they needed beds," said Ab Brody, professor of geriatric nursing at New York University and author of a recent editorial on hospital home care in the Journal of the American Geriatrics Society. "And they needed a safe place for the elderly, who were especially at risk."
In November 2020, Medicare officials announced that while As the federally declared public health emergency continues, hospitals may request a waiver of certain reimbursement requirements, including for 24/7 on-site nursing care. Hospitals whose requests have been approved would receive the same payment for hospital care at home as for hospital care.
Since then, Medicare has granted waivers to 256 hospitals in 37 states, including the Mount Sinai in New York and the Baylor Scott and White Medical Center in Temple, Texas. Initially, hospital-at-home programs primarily treated common acute illnesses such as pneumonia, urinary tract infections, and heart failure; more recently they have also begun to deal with liver disease treatments, post-surgical care and aspects of cancer care.
Uncertainty as to the future involvement of Medicare prevents wider adoption of the approach. “If this were to become permanent, you would see at least a thousand hospitals in the next few years” adopt hospital home care, said Dr. Bruce Leff, a geriatrician at Johns Hopkins University School of Medicine who started one of these treatments. programs.
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