Suppose your dad is a senior citizen who is admitted to a hospital because of pneumonia. The noise all the time interferes with his sleep. He's confused. Then, an unexpected solution is provided by a doctor. He would be able to enjoy the same treatment at home. This isn't a futuristic dream. It's the rapidly expanding reality of Hospital-at-Home programs. This model is changing treatment due to a crisis in post acute care facilities and new government waivers. But can this comfortable way of solution fit every family and patient? The solution is not that simple.
The Ideal Storm of Post-Acute Care
Our system is in its death-throes. The problem of workforce shortage in Skilled Nursing Facilities (SNFs) is devastating. Most of them are unable to accept new patients. This poses a threatening backlog in hospitals. Patients occupying the beds are those who are in a position of leaving but have no place to go. As a result, the Emergency rooms become congested. Surgeries that are elective are canceled. The whole healthcare continuum is victimized. According to a recent report, the nursing home industry has lost more than 210,000 jobs since 2020 based on a report that was released by the American Health Care Association. This downfall poses an immediate demand of substitutes. The Post-Acute Care crisis exists.
Inside a Hospital-at-Home Visit
But what does acute care at home mean? It is much more advanced than every day check-in.
- Technology is the backbone. Vital signs tracking Bluetooth-enabled patches are worn by patients.
- These gadgets relay information such as heart rate and oxygen levels which are sent directly to a clinical command center.
- An alarm is raised on any worrisome trend.
A nurse can come to do a blood draw. An IV could be administered by a paramedic. In the meantime, the patient is lying on his or her bed. They eat their own food. They are not exposed to hospital-acquired diseases. Research, and groundbreaking research by Johns Hopkins, demonstrates great results. Indicatively, in these programs, the incidences of delirium are much less. The scores of satisfaction in patients are always high. It's a powerful proposition.
The Hidden Caregiver Burden
But, this model brings about an earth-altering, frequently unsuspected, change of responsibility. Who changes the bed linens? Who monitors the patient to take his or her medication on time? It is normally one of the members of the family. The Hospital-at-Home model effectively deputizes spouses and adult children as frontline clinical support. This may be a daunting responsibility.
"Dr. Alicia Chen, a geriatrician, says that the families are being asked to juggle medical high stakes and with little training." According to the author, the system is in danger of resolving its capacity issue to produce a giant silent catastrophe in care giver burnout.
The human emotional impact is great. The living room of a family turns into an ICU. There is no clocking out. Such close attention can do away with the very individuals who are giving the much needed assistance.
A Real Life example: The Carter Family.
Consider the Carters. Arthur, 82, was discharged from the hospital with a Hospital-at-Home program after a heart failure episode. Margaret, 79, his wife, became his first aid. She had difficulty linking the tablet to have telehealth appointments. She was always afraid of failing to receive a vital alert of the blood pressure device. Margaret told us that she felt like 24-hour duty. "I love him, but I'm not a nurse. I feared I should go wrong of my step. Their account shows the disconnect between the clinical instruction and the practical performance.
The Digital Divide in Modern Elder Care
The Elder Care revolution requires a strong Wi-Fi connection. This generates a severe equity issue. What of the aging population in the countryside who have low broadband connection? What of the un-tech savvy individuals who are unable to afford the technology? Or the people who are not digital savvy to operate it? The Hospital-at-Home model, in its current form, risks becoming a premium service. It may easily create a very big rift in health disparities. We need to establish a system that caters to every senior not only the well-linked and the wealthy.
The Information is a Mind-Stunning Story
Regardless of such difficulties, it is difficult to overlook the clinical and economic data. The Acute Hospital Care at Home waiver was launched by Centers of Medicare and Medicaid Services (CMS) in 2020. Approved programs are currently in place in over 300 hospitals in the U.S. Early data is promising. A single large health system was able to report 25 percent decreased 30-day readmission rates of its HaH patients. In another study it was established that the costs were 19 percent cheaper than in the traditional inpatient care. These figures justify the fast growth of this model. There is close attention being given by the policy makers and insurers.
The Special Vision of a Geriatrician
We usually perceive this in the light of a strictly medical or economic standpoint. But human good can be profoundly human. Dr. Lena Vance, who leads a Hospital-at-Home program, shared a poignant insight. One of the nonverbal patients in the hospital was a patient with dementia. She began speaking again the moment she got home. The familiar surroundings made her the ultimate cure and we could never have offered anything to her. This opinion re-processes the whole discussion. To some, place is deeply associated with healing. The very house may be therapeutic. This is a dimension of Elder Care we frequently underestimate.
Finding a Pathway on the Future of Post-Acute Care
The expansion of Hospital-at-Home is inevitable. The incentives are excessive in terms of money and patient-satisfaction. But still we cannot allow impetus to prevail over intelligent execution. Family caregivers have to be provided with strong support frameworks. The digital equity issue needs to be resolved. Future of Post-Acute Care cannot be the same solution to all the problems. It has to be a dynamic, humane, and fair ecosystem. The systems should be changed in order to serve the entire family, and not only the patient.
An Exhausted, Uncomfortable Question.
Ultimately, the rise of Hospital-at-Home forces us to ask a difficult question. Are we creating a more humane future for Elder Care, or are we simply dismantling the hospital and reassembling its burdens inside the family home? The success of the model will not be determined on cost savings or readmission rates only. Its actual legacy will be decided upon the extent of its supportiveness to the entire circle of care. When we are trying to heal the patients, we should also make sure we do not destroy the families that love the patient.
