The “Hospital at Home” concept is not new. Johns Hopkins has provided acute care to older adults at home for years. But the pandemic has increased demand for at-home clinical care, and the hospital at home model and medically directed home care are both seeing elevated demand in the marketplace. This article looks at the performance strengths of both types of in-home care.

Hospital at Home: Saving costs and improving lives

Hospital at home models have reported cost savings of up to 30% in comparison to inpatient stays, as well as improved patient satisfaction and medical outcomes.

The advent of telemedicine, teletherapy, remote monitoring, and technology-supported care is making the case for hospital at home care even stronger. No wonder leaders such as the Mayo Clinic are shifting to this model of care. Along with concierge medicine and personalized medicine, hospital at home services are establishing a new standard for premium, individualized healthcare services.

Medically directed home care: Reducing hospitalizations and improving multiple conditions

The value of medically directed home care is still being understood, but historically, research has indicated positive outcomes in several areas.

  • Functional status. Home care interventions are known to reduce symptoms, improve physical capabilities, increase mastery of ADLs, and produce better quality of life.
  • Pain management. Home care has been shown to reduce reported pain intensity levels.
  • Incontinence. This condition shows reduced severity and frequency with home care support.
  • Mental health. Significant improvements have been reported in the occurrence and severity of depression.
  • Education. When home care professionals provide information, patient confidence and family preparedness increase.
  • Reduced unplanned hospitalizations. Home care has reduced hospital utilization significantly - by as much as 52%.
  • Reduced healthcare spending? Preliminary evidence from 2020 shows that home care may play a role in lowering overall healthcare spending specifically hospital, nursing home, and clinical services.

Medically directed home care also is known to help with fall prevention, medication management, wound management, family caregiver respite, and many other aspects of living at home with chronic conditions.

The effectiveness of these capabilities – along with the pandemic, the prevalence of chronic diseases and the aging of the global population - explains why home care is expected to grow at nearly 9% annually as an industry.

Home care’s ability to reduce hospitalizations

52%

A 2015 BMC Health Services Research study of medically complex patients showed a 47% – 52% decrease in hospital admissions when home care support was provided.

What’s Next: The Merging of Home Care and Hospital at Home Care?

A 2021 article in Home Health Care News pointed out that “private-duty home care agencies looking to take part in hospital-at-home models need to invest in building an on-call workforce capable of responding to a range of medical emergencies.”

We at SeniorBridge agree. The clinical capabilities of home care agencies will determine which ones can step up to higher levels of client care. Responsiveness will also be a factor.

A 2021 AMA article identified the levels of complexity that needs to be addressed. “You need the interface between a hospital record and all the physician orders,” said Dr Stephen Parodi, an infectious diseases physician affiliated with Kaiser Permanente. “Then getting that translated into literally 18 different services that have to be delivered at the speed of care. We've got to be able to get the doctor's orders, the fluids, the medications delivered to that patient's home within a course of hours—not days."

For now, medically directed home care and hospital at home care models remain separate.

But the potential for a more enmeshed relationship exists. In the words of Abena Agyemang-Panbour, a SeniorBridge HHA in the metro-NYC area, “once the patient is home, I do daily reports, and the Registered Nurse Care Manager checks in every two weeks to monitor changes. Plus there’s a monthly reassessment. That’s how we can be an extension of the eyes and ears of the client’s medical team.”

“Once the patient is home, I do daily reports, and the Registered Nurse Care Manager checks in every two weeks to monitor changes. Plus there’s a monthly reassessment. That’s how we can be an extension of the eyes and ears of the client’s medical team.”

Abena Agyemang-Panbour, SeniorBridge HHA

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on medically directed home care, contact SeniorBridge.

Sources consulted:
Johns Hopkins Medicine (2021)
Commonwealth Fund (2021)
Mayo Clinic News Network (2020)
National Library of Medicine/NIH (2008)
BMC Health Services (2015)
Home Health Care News (2021)
Biospace (2021)

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