When most people hear about hospital-at-home programs, they often picture ICU nurses and doctors running around their living room.
But while hospital-at-home models do rely on physicians and clinical staff, successful programs also leverage the expertise of private-duty home care agencies and their veteran caregivers.
In fact, when hospital-at-home models fail, it’s typically because a caregiver isn’t around to serve as “the eyes and ears” of the home.
“Advanced care in the home requires a complete, interdisciplinary approach,” Summer Napier, CEO and owner of Healing Hands Healthcare LLC, said Tuesday during a virtual event hosted by the National Association for Home Care & Hospice (NAHC). “I think that gets thrown around a lot, but I don’t think that [private-duty home care agencies] always realize they are part of that interdisciplinary team.”
Healing Hands Healthcare is a for-profit in-home care provider that serves nearly two dozen counties in Texas. Its offerings range from skilled nursing care and therapy services, to medical license social working and private-duty home care.
“You should have a seat at the table on every discussion,” Napier said, specifically speaking at the 2021 Winter Leadership Summit hosted by NAHC’s private-duty home care affiliate.
Led by the likes of Johns Hopkins, Mount Sinai and others, active hospital-at-home programs have been around for years in the U.S. Logistical and reimbursement challenges meant they remained relatively few and far between until last year, however.
In 2020, more hospitals began launching such models in response to the COVID-19 pandemic and a need to increase in-patient bed capacity. In November, the U.S. Centers for Medicare & Medicaid Services (CMS) even launched a dedicated “Acute Hospital Care at Home” waiver to temporarily eliminate certain payment barriers.
As of Feb. 19, there were at least 44 health systems and 103 hospitals in 28 states participating in the CMS program, federal data shows. At least six participants have secured a waiver in February alone.
Those who follow health care trends shouldn’t be overly surprised by the waiver program’s popularity, Sheila Davis, vice president of area operations for Always Best Care Senior Services, suggested during the NAHC event.
Always Best Care is a home care franchise company that operates across 209 territories in 30 states.
“We saw a significant shift after the 90s with assisted living and skilled nursing facilities,” Davis said. “But now amidst the pandemic, we’re seeing the opposite effect, where [patients] are really choosing to age in place in their own home. And the patient care model of the future is that of hospital-at-home.”
Among their many benefits, hospital-at-home models have been found to achieve cost savings of 19% to 30% compared to traditional in-patient stays. Additionally, models often have shorter lengths of stay compared to normal trips to the hospital, plus higher patient satisfaction and functional outcomes.
“Compared to similar hospitalized patients, hospital-at-home patients experience better clinical outcomes and have lower rates of mortality,” Davis said. “They also have a better mindset and medication usage.”
Both Always Best Care and Healing Hands Healthcare have carved out roles in hospital-at-home programs in their markets, Davis and Napier said at the NAHC event.
Despite a lack of immediate opportunities, Healing Hands Healthcare had actually been putting together the framework to enable hospital-at-home programs long before COVID-19, Napier noted.
“I’ve been talking about our hospital-at-home program before it was a real thing for home health agencies — and people laughed at me,” she recalled. “It was never the right time, it was never the right time. And then guess what? The right time came — and guess who [hospital partners] reached out to?”
Having its ready-to-go program and priorities in place has helped Healing Hands Healthcare serve more than 300 hospital-at-home patients since the pandemic began.
Overall, the organization has been able to keep 96% of those individuals at home and out of the brick-and-mortar hospital setting.
Broadly, 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, Napier and Davis advised.
To be successful, agencies must likewise double down on caregiver training and education. A good place to start is by developing programs for specific complex conditions, such as congestive heart failure (CHF), COPD, dementia and more.
“Sometimes we get overwhelmed with the details,” Napier said. “A hospital-at-home program can be the same as a CHF program, though you may call it different things at different times for marketing purposes. The fact of the matter is, you need to be able to take care of sick patients.”
As far as finding hospital-at-home opportunities, private-duty agencies need to first determine the appetite for services in their markets. A good starting point is connecting with existing hospital partners, Davis said.
Partly due to its size and established partnerships, Always Best Care had hospitals reach out first.
“From the perspective of a large-scale agency, if you do have many different locations, sometimes it’s approaching the local hospitals or the bigger hospitals and saying, ‘Do you already have a hospital-at-home program in place?’” Davis said. “‘Do you need ancillary services to be a part of that program?’”
With the hospital-at-home programs they enable, Always Best Care and Healing Hands usually receive payment directly from patients and families.
“In Texas, we don’t have a ton of shared-risk models yet,” Napier said. “About 90% of it is the family saying, ‘I want [my loved one] home. I know they’re going to do better at home.’”