Hospital at Home & Covid-19

As the Nation seeks ways to provide safer care to a vulnerable population, post acute care services will undoubtedly play an increasingly important role in the healthcare system .  In the current times (COVID-19 pandemic), home care industry is best positioned to provide safe care in the comfort of patient’s home.  

Hospital at home programs are gaining popularity during this pandemic,  and thus I wanted to share some components of existing programs, and my thoughts on “if you decide to go down the path!” 

Transfer Model

• Patient is transitioned earlier (then traditionally estimated) from in-patient unit to home depending on strict clinical criteria and Physician to Physician collaboration and referral. 
• The transfer model is for population at reduced risk of :
  • Further exacerbation of symptoms and can safely finish care in home settings.
  • Exacerbation of symptoms while being at high risk of iatrogenic complications and would be safer in familiar home environment.
    • This model can help facilitate care for the elderly patient who are at risk for COVID-19 and other SNF related complications
  • The transfer model can be designed to help reduce hospital length of stay (LOS) and to defer Skilled Nursing Facility (SNF) placement
  • The patient that will qualify for this model may be recovering from COVID-19, stroke or medical and surgical procedure or a chronic condition exacerbation.

The Substitute model

• Patient completely avoids admission to an acute care facility after assessment in ambulatory site or emergency department, Urgent Care Center or at home by a house call MD/NP.
• The substitute approach can prevent the “leakage readmits” and provide appropriate level of care and reduction in overutilization of resources. 
• The referrals for this model of care will be received from community physicians, house call programs and other ambulatory sites that have identified a “revolving door” patient.   

Conditions that can be managed and treated under hospital at home will have the following characteristics in common:

• Diagnosis is relatively uncomplicated and can be made rapidly without much consultation or invasive testing
• Treatment is well defined and can be delivered in a feasible, safe, and efficient manner at home

If you are an organization planning on starting Advanced Home Care or a Hospital at Home program, my recommendations are as following:

1. Identify your goals and outcomes you would like the program to impact!
   1. Build a dashboard to track progress
2. Develop clear service description and eligibility criteria
3. Before you design the program, get stakeholder’s buy-ins
   1. Local area hospitals, ERs, Urgent Cares, Community Physicians, Skilled Nursing Facilities etc. 
4. Utilize community resources and build partnerships!