Hospital-at-Home Model a New Competitor for Skilled Nursing?

In the healthcare world, skilled nursing facilities are often a stop for elderly patients transitioning home from the hospital, but an emerging “hospital at home” model could eliminate that stop by keeping some chronically ill patients at home the whole time.

Kaiser Health News reports

“Hospital at home” programs fundamentally refashion care for chronically ill patients who have acute medical problems — testing traditional notions of how services should be delivered when people become seriously ill. Only a handful of such initiatives exist, including the Albuquerque program, run by Presbyterian Healthcare Services, and programs in Portland, Ore., Honolulu, Boise, Idaho, and New Orleans offered through the Veterans Health Administration.


But the concept – which has been adopted in Australia, England, Israel and Canada — is getting attention here with increased pressure from the national health overhaul to improve the quality of medical care and lower costs. Hospital at home programs do both, according to research led by Dr. Bruce Leff, the director of geriatric health services research at Johns Hopkins School of Medicine in Baltimore who pioneered the concept.

In a study of three experimental hospital at home programs published in 2005 in the Annals of Internal Medicine, Leff demonstrated that patient outcomes were similar or better, satisfaction was higher and costs were 32 percent less than for traditional hospitalizations.

“It’s a very successful model and in five years, I think it’s going to be very common.  But we’re still in the early adoption phase,” said Mark McClelland, an assistant professor at the Center for Health Care Quality at George Washington University.


Despite McClelland’s expectations, this isn’t a model that health care providers are seeing a lot of—so far, at least, says Greg Crist, vice president of public affairs at the American Health Care Association. 

“We’d be hard pressed to see much of a market there because of the complexity of the patients,” Crist says, although he acknowledged there is demand for such a model.

Hospital-at-home models can’t offer the efficiency a skilled nursing center can in terms of having multiple staff available to help residents at various points of need, he says. Additionally, a patient receiving these services at home may eventually need certain medical equipment that’s immediately available at a facility, but would take time to obtain in a home setting. 

“Around-the-clock care is very expensive, and even though there are Americans who can afford that, we don’t see that being replicated on a massive scale,” he says.

Read the full Kaiser Health News article

Written by Alyssa Gerace

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