- Executive summary
- The evolution of patient care
- The rise of the hospital-at-home model
- Hospital-level care, at home
- The future of healthcare or a threat to patient safety?
- Better patient outcomes, lower costs
- What will the future of healthcare look like?
Executive summary:
Healthcare systems worldwide are facing a difficult future due to challenges such as ageing populations, understaffing and bed shortages. Several solutions have been proposed, including a system that allows patients to receive hospital-level care within the comfort of their own homes. This could potentially result in reduced mortality rates, lower care costs, and improved patient satisfaction.
- Boston Medical Center, Hackensack Meridian Health, and Hospital Clínic Barcelona are some of the healthcare institutions offering hospital-at-home programmes.
- There are more than 300 hospitals offering such programmes in the United States alone.
- McKinsey estimates that up to 25% of patient care services could be offered at home by 2025.
- “There’s no greater patient-centred care than care delivered in an individual’s home setting,” says Heather O’Sullivan, president of Mass General Brigham Hospital’s Healthcare at Home.
- “This isn’t home health light, it is true hospital-level care,” says Colleen Hole, a vice president and chief nurse executive of healthcare company Atrium Health.
In the coming years, we may very well see more medical services being offered outside of hospitals. While it’s clear that not everything can be done in a home setting, the answer may lie in understanding where exactly to draw the line. We’ll also need to find a way to ensure that any changes in the delivery of medical care benefit all members of society, not just its more affluent constituents.
The evolution of patient care
Nobody relishes the thought of a hospital stay. The sterile environment, unfamiliar surroundings, and disruption to daily routines can be unsettling for patients of all ages. Yet, when faced with severe illness or injury, a trip to the hospital often becomes an unavoidable necessity. However, this traditional approach to medical care isn’t without its risks. Extended hospital stays can lead to complications like hospital-acquired infections, falls, and cognitive decline, particularly for vulnerable populations such as the elderly.
Recognising these challenges, alongside growing concerns about ageing populations, hospital overcrowding, understaffing and bed shortages, healthcare providers are increasingly turning to alternative solutions such as hospital-at-home. This innovative concept allows eligible patients to receive hospital-level care from the comfort of their own bed. In this article, we will take a closer look at this new stage in the evolution of patient care and explore how it could pave the way for a more flexible, patient-centred approach to healthcare.
The rise of the hospital-at-home model
Patient care is increasingly moving away from traditional medical facilities into the home environment without negatively affecting the quality of care.
So, how exactly does a hospital-at-home programme work? While the specifics may vary from one hospital to the next, the process typically starts when a patient is admitted to the emergency room. If it’s determined that the patient requires hospitalisation, the doctor then evaluates whether they are suitable to receive care at home by assessing a range of factors, including their physical and mental condition, symptoms, stage of the illness, and any existing comorbidities. Before the patient is sent home, a social worker also examines their home environment to determine whether it meets the social inclusion criteria, which may entail having electricity, running water, internet access, and heating or air conditioning, as well as being located within 30 minutes of an actual hospital.
Once the home is deemed safe and the patient consents to participate in the programme, they are transferred home and equipped with various remote monitoring devices that allow doctors to keep track of their condition from a distance and respond to any emergencies in a timely manner. Typically, patients are examined twice daily by a nurse or community paramedic. They also receive a daily visit from the doctor in charge of their care, either in person or over a video call. Currently, services offered by hospital-at-home programmes include IV medications, infusions, basic lab tests, and electrocardiograms. In some cases, patients may even be able to perform imaging tests like ultrasounds or X-rays.
Studies have shown that hospital-at-home programmes can benefit patients in numerous ways. Compared to in-hospital stays, they can reduce mortality rates, lower costs, and improve patient satisfaction. Being surrounded by their loved ones, sleeping in their own bed, and eating home-cooked meals can do wonders for the patient’s state of mind, which in turn improves their chances of recovery. Some even argue that hospital-at-home programmes could also expand access to healthcare, especially for underserved communities living in rural areas.
However, there are also certain challenges that may prevent wider adoption of the hospital-at-home model. Probably the biggest one is that the strict eligibility criteria—meant to ensure patient safety—will prevent many patients from participating in these programmes in the first place. After all, not everyone has access to high-speed internet, which is crucial for remote monitoring devices to function properly. Another issue that often goes overlooked is the impact on family caregivers, who suddenly find themselves faced with a tremendous amount of responsibility with very little preparation. This can have a significant emotional toll, in addition to being a major drain on finances. There is also the matter of compliance with treatment regimens, which may be more difficult to ensure when patients are outside of a hospital.
“The quality of care that’s delivered is excellent—less chance of patients that are staying in a hospital getting an infection. The patient experience is a better one.”
Robert Garrett, chief executive of Hackensack Meridian Health
Hospital-level care, at home
Hospitals around the world have launched programmes that allow patients to receive hospital-level care in the comfort of their own homes.
A growing number of hospitals worldwide now offer hospital-at-home programmes. For example, Boston Medical Center announced the launch of a new hospital-at-home service earlier this year. Each patient enrolled in the programme is equipped with a virtual hospital room kit, which consists of remote monitoring devices that measure the patient’s vital signs around the clock, an emergency response bracelet, a tablet for telehealth video visits, and a phone that enables patients to connect directly with their care team. Every day, patients will receive at least two in-person visits from a physician, and they will have the option to schedule more if necessary. They will also be able to request a range of other services, including physical and occupational therapies, infusion therapies, and meal deliveries.
Similarly, Hackensack Meridian Health, the largest integrated healthcare network in New Jersey, joined forces with healthcare company Medically Home Group to launch a new programme called Hospital From Home, which will enable patients to access a wide range of care services without having to leave their homes, including medical imaging, laboratory services, IV antibiotics, and physical, occupational, speech, and respiratory therapy. “The idea of providing acute care services within the comfort of your own home is very attractive for the patients,” says Robert Garrett, chief executive of Hackensack Meridian Health. “The quality of care that’s delivered is excellent—less chance of patients that are staying in a hospital getting an infection. The patient experience is a better one.”
The notion of providing patients with medical care in the privacy of their own homes is also gaining traction in Europe. In Spain, the Hospital Clínic Barcelona has been running a hospital-at-home programme aimed at children and adolescents with severe mental health disorders since 2021. The programme is led by the hospital’s home hospitalisation unit, which is comprised of a child psychiatrist and two nurses. Each patient receives a personalised treatment tailored specifically to their individual needs, which is done in close collaboration with their families. In addition to daily visits from the psychiatrist and nurse, this also includes coordination with schools and social services to ensure a smooth transition to everyday activities.
“I don’t think we’re going to be taking out your gall bladder in your living room. But in 10 years, we will be admitting all the classic medical admissions that are just better at home.”
Mark Prather, executive chairman of hospital-at-home operator Dispatch Health
The future of healthcare or a threat to patient safety?
Industry experts have mixed feelings about the hospital-at-home model. Some believe that it’s the future of patient care, while others consider it potentially dangerous.
Proponents of the hospital-at-home model claim that it offers numerous advantages. “There’s no greater patient-centred care than care delivered in an individual’s home setting where they’re often most comfortable with their own sleeping accommodations and clothing, in addition to having easy access to their loved ones and their pets, who are often important elements in the return to health,” says Heather O’Sullivan, president of Mass General Brigham Hospital’s Healthcare at Home. Most importantly, she argues, patients receive the same quality of care they would in a hospital. “This isn’t home health light, it is true hospital-level care,” remarks Colleen Hole, a vice president and chief nurse executive of healthcare company Atrium Health.
This doesn’t mean that hospitals will no longer be necessary, though. “I don’t think we’re going to be taking out your gall bladder in your living room,” says Mark Prather, co-founder and executive chairman of hospital-at-home operator Dispatch Health. “But in 10 years, we will be admitting all the classic medical admissions that are just better at home.” Mark Howell, director of policy for the American Hospital Association, shares a similar view. “There’s always going to be reasons you have to go to the hospital, right? We’re not going to mail you an open-heart surgery kit,” he says.
However, some medical professionals are categorically opposed to the idea of acute patients receiving care at home, with some going so far as to call it dangerous and a grave threat to patient safety. “Devices being deployed in patients’ homes can malfunction and give erroneous readings,” explains Michelle Mahon, assistant director of nursing practices at National Nurses United, the largest union and professional association of registered nurses in the US. “There are also user curves. Imagine you’re very sick, running a high fever, can barely see straight and now you’re supposed to enter your own vital signs into an app or tool that maybe you can’t even see properly?”
There are also concerns about how quickly a care provider can respond if a patient experiences a medical emergency at home. “In the hospital, we are able to respond to a patient’s change of condition and recognise it before it becomes a crisis,” continues Mahon. “Often, those changes are detected by skilled nurses before the data shows there’s a problem, especially in elderly people. There might be subtle changes in the way they talk or in their cognition, glassy eyes or in the smell of their breath. We can respond within seconds.”
Better patient outcomes, lower costs
Studies have shown that hospital-at-home programmes can lead to reduced mortality and readmission rates, lower costs, and higher patient satisfaction.
There is a growing body of evidence to suggest that the hospital-at-home model can support better patient outcomes. A January 2024 study by Harvard Medical School and Mass General Brigham healthcare system found that patients enrolled in hospital-at-home programmes had a mortality rate of just 0.5% during hospitalisation, while 6.2% were readmitted to the hospital for at least 24 hours. In the 30 days following the discharge, the mortality rate increased to 3.2%, with another 15.6% of patients readmitted. For comparison, the mortality rate for patients admitted to hospitals in England was around 3% in 2023, according to NHS data.
In addition to improving clinical outcomes, the hospital-at-home model has also been shown to reduce patient care costs. A 2019 controlled trial led by David Levine, assistant professor of medicine at Harvard Medical School, revealed that the cost of the acute care episode for patients receiving care at home was 38% lower than for in-hospital patients. Additionally, home patients were more physically active, spending 12% of their day sedentary and 18% lying down. On the other hand, in-hospital patients spent 23% of their day sitting down and 55% lying in their beds. Home patients also had lower readmission rates at 7%, as opposed to 23% for in-hospital patients.
Patients themselves seem to be in favour of the hospital-at-home model. A 2024 survey conducted by digital healthcare solutions provider Vivalink, which included more than 1,000 participants over the age of 40, found that 84% were willing to take part in a hospital-at-home programme. Of those who had already been enrolled in such programmes, 84% said they had a positive experience, while 49% said remote patient monitoring devices were easy to use. However, device usability may yet prove a barrier to more widespread adoption: 16% of respondents indicated they were unlikely to participate in hospital-at-home programmes due to fears that the technology may not be user-friendly.
Despite these concerns, the hospital-at-home model is becoming increasingly popular, with more than 300 hospitals offering such programmes in the United States alone. What’s more, McKinsey estimates that up to 25% of patient care services (with a market value totalling around US$265 billion) could be offered at home by 2025 rather than in traditional medical facilities.
What will the future of healthcare look like?
As the hospital-at-home model continues to demonstrate its effectiveness, it’s likely that we’ll see a substantial expansion of such programmes in the coming years. This could dramatically reshape the healthcare landscape, offering patients more choices and potentially alleviating pressure on traditional medical facilities. On the other hand, the widespread adoption of hospital-at-home programmes could exacerbate existing inequalities in access to care, as patients in urban areas with robust internet infrastructure and proximity to medical facilities may find it easier to access these services compared to those living in rural communities.
Looking further into the future, the integration of AI and advanced telemedicine platforms could significantly enhance the capabilities of hospital-at-home programmes. AI-powered diagnostic tools could analyse data from wearable devices in real time, predicting potential complications before they occur and allowing for more proactive interventions. Telemedicine, already a cornerstone of these programmes, could evolve even further to allow for augmented reality consultations, where specialists guide local caregivers through complex procedures remotely.
Learnings:
As we’ve explored throughout this article, the emergence of the hospital-at-home model represents a significant shift in how we approach patient care. While it offers some compelling benefits for patients and hospitals alike, it also raises important questions about healthcare equity, patient safety, and the role of technology in medical care. The success stories and positive patient experiences highlight the model’s potential, yet the concerns raised by critics serve as a timely reminder of the need to proceed with caution.
- Hospital-at-home programmes have been reported to reduce mortality rates, lower care costs, and improve patient satisfaction.
- They also enable hospitals to free up beds for patients in more serious conditions.
- Critics worry that removing patients from a hospital environment could endanger their safety.
- There are also concerns that hospital-at-home programmes may exacerbate existing inequalities in access to medical care.
So, how do we ensure that those without the necessary resources aren’t left behind? Can we strike a balance between the comfort of home and the safety net of a hospital? The answer to these questions may very well determine what the future of healthcare holds for us—and where we can expect to receive treatment.
