How Does Hospital at Home Work? Overview and FAQ
Home care has long been a valuable option for patients who need help managing conditions in the comfort of their own homes. However, in more recent years, the emerging hospital at home (HaH) model has taken this concept a step further, enabling patients to receive acute-level care services at home as well. While this approach is still relatively new, it has shown promise in decreasing costs, improving care accessibility, and enhancing the overall patient experience.
If you’re a facility leader, you may be wondering whether you should offer an HaH program for your patients. To help you make a more informed decision, we’ll provide an overview of HaH by answering the most frequently asked questions about this care model.
What Is Hospital at Home?
HaH is the delivery of hospital-level services within a patient’s home — offering an alternative for patients who can’t (or refuse) to be admitted into a facility. The HaH model was first implemented in the U.S. in 1995 as a way to protect elderly patients at risk of hospital-acquired infections. It’s since been adopted by select facilities across the U.S. and has even become a popular model of care in other countries, including Canada and Australia.
Who Qualifies for Hospital at Home?
While HaH is designed for those who are sick enough hospitalized, patients must still be deemed stable enough to be treated at home. Individuals who need intensive care from multiple different specialists each day should generally be kept at the hospital. However, patients with conditions that have regimented protocols, such as congestive heart failure, are usually good candidates for HaH services.
How Does HaH Care Work?
Every facility will have a slightly different process for managing HaH. However, we can take a look at a general, step-by-step example of how a patient might complete these services below.
- A provider at the emergency room sees a patient who may be a good fit for HaH.
- The provider conducts an assessment and determines that the patient is eligible.
- The patient is assigned a lead provider who is responsible for their home care.
- The facility arranges for a coordinator to discuss HaH with the patient, evaluate the patient’s home environment, and arrange their transportation home.
- The lead provider meets with the patient at their home, either in person or via video call, to discuss their plan of care.
- Specialists, nurses, and caregivers arrive at the patients home each day to deliver treatments and conduct exams.
- In between home visits, the nurses utilize remote patient monitoring tools to continuously monitor the patient’s status.
- The assigned provider checks in with the patient on a daily basis until they’re stable enough to be handed off to their primary care provider.
How Is a Hospital at Home Program Staffed?
Similar to in-hospital services, HaH services are staffed using a multidisciplinary team. Fundamentally, facilities must ensure that patients enrolled in HaH can be safely monitored and cared for on a 24/7 basis.
We’ll outline the core structure of an HaH team in the table below. However, a patient’s specific needs may require the involvement of other types of specialists and therapists in HaH care services.
| Staff Member | Role in HAH Care Process |
|---|---|
| Clinical director | Oversees the overall strategic vision and operations of HaH |
| Coordinator | Handles the logistics of enrollment, care, and supply delivery |
| Lead provider | Manages the patient’s plan of care |
| Nurses and aides | Provide daily home care, also bringing key supplies (e.g., IVs) |
| Social worker | Connects patients with essential community-based services |
| Physical therapist | Develops a plan of care that improves mobility and strength |
| Administrative assistants | Handle patient phone calls, paperwork, and case-finding |
Does Medicare Pay for HaH?
While Medicare covers more traditional home health care services (i.e., intermittent care), it does not cover the level of care delivered under HaH. The Centers for Medicare and Medicaid Services (CMS) previously provided coverage for hospitals participating in the agency’s Acute Hospital Care at Home pilot program. However, this program expired in December of 2024 and has yet to be extended.
What Are the Benefits of HaH?
While HaH has not been widely adopted, preliminary studies have shown that it may offer many unique benefits for patients, providers, and the overall healthcare system. Here are a few examples of how HaH programs and initiatives have helped improved care:
- The CMS hospital at home program led to over $1 million dollars in savings per hospital, with some hospitals experiencing up to a 44% reduction in 30-day readmission rates.
- Early pilot programs of HaH have led to increased patient satisfaction and clinical outcomes that were comparable to in-patient care services.
- HaH programs have helped expand the capacity of hospitals, freeing up in-patient beds for those who need higher acuity care.
What Are Common Barriers to Implementing HaH?
Despite the benefits associated with HaH, the lack of standardized hospital at home guidelines and regulations has led to some ongoing challenges. Here are three potential barriers to consider before implementing this care model.
Physician Resistance
Physicians have concerns about the overall efficiency of HaH, given the amount of time it takes to introduce and acclimate patients to these services. In fact, studies have shown that HaH providers may spend an average of 20.5% of their time outside of home visits on care coordination activities. Many of these hours are not reimbursed, which can lead to unpaid overtime and increased burn out.
Inconsistent Reimbursement Policies
Many patients are also resistant to enrolling in HaH because of limited insurance coverage. Similar to Medicare, few private insurance providers cover HaH admissions or care services. Insurance providers that do offer coverage often have very complex standards and policies.
Patient Safety
While HaH services involve frequent care visits and remote monitoring, many healthcare stakeholders remain concerned about patient safety. HaH patients often struggle with medication adherence and may face a higher risk of fall-related injuries. Even with an emergency response team on call, remote monitoring can delay responses to urgent issues — also increasing legal risks for facilities and providers.
What Will the Future of Home Care Look Like?
Since the COVID-19 pandemic, there has been a significant expansion of hospital at home. Future trends will likely focus on overcoming the existing challenges of scaling up this care model. There’s still much that needs to be done to improve the efficiency and regulation of HaH services. But as technology continues to advance, there’s potential to automate administrative tasks that would allow providers to focus more on the care delivery aspects of HaH.
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