Hospital-Level Care at Home for Serious Conditions Grows in Popularity During Pandemic

Hospital care at home is nothing new for patients with low-level health needs. But since the pandemic began, a growing number of health care providers – including Adventist Health, the Mayo Clinic and California health care giant Kaiser Permanente – are offering people with more serious health conditions hospital-level treatment in the comfort of their homes.

It’s something Janet Yetenekian, who lives in Glendale with her family, experienced this year after she came down with a severe case of COVID-19.

Back in December, with pandemic isolation finally getting to Yetenekian, her husband and two teenage kids, the family accepted an invitation to join an afternoon barbecue.

“We just go, ‘OK, we’ve been home all this time,’ you know, ‘Let’s just go a few hours and come back,’ ” Yetenekian said.

But the day after the gathering, the host came down with fever. A test confirmed it was COVID-19. Within two weeks, Yetenekian’s husband and kids got mild cases of the disease while her blood oxygen plummeted to dangerously low levels.

“And a few days later, I had to go to the hospital,” she said.

Treatment included an IV drip of the antiviral drug Remdesivir and constant monitoring — things normally done in a hospital. So it surprised Yetenekian when her doctor at Adventist Health offered to move all her care home to be monitored virtually.

“It was even better than the hospital,” she said. “They were constantly reaching out, ‘It’s time for you to do your vitals,’ or ‘It’s time for you to take your medications.’ ”

Doctors and nurses at a command center nearly 200 miles away managed Yetenekian’s care as part of a new federal effort aimed at freeing up hospital beds during public health emergencies. Under the model, about 60 illnesses, including COVID-19, qualify for home treatment.

“Heart failure, pneumonia, skin infections — those are all patient populations we can safely care for in the home,” said Dr. Margaret Paulson, who leads the Mayo Clinic’s new home-based care program in rural Wisconsin.

Paulson said once her patients understand that home care does not mean less care, they eagerly embrace it.

“Especially for patients who have been in the hospital a lot, to know that they can actually go home and sleep in their own bed and be with their family and have their pets by their side, it’s just really reassuring,” she said.

And studies suggest at-home care provides better outcomes for patients and costs less to provide than traditional inpatient care.

“This is actually a higher level of touch from physicians and advanced practitioners,” said Dr. Kavita Patel, a physician and health policy fellow at the Brookings Institution.

Regularly scheduled video conferencing and 24/7 monitoring is augmented by twice-daily, in-person visits by nurses and other health workers who provide basic care like antibiotics.

“This isn’t just sending mom or dad to the bedroom,” she said.

Patel said it’s the technology infrastructure that’s key: Wi-Fi phones that ring directly into a hospital’s command center, iPads that allow video conferencing with health professionals and wearable devices with emergency call buttons.

Raphael Rakowski is co-founder of Medically Home, the tech company that supports at-home programs for Adventist Health, Mayo Clinic and Kaiser Permanente. On Thursday, those latter two health care entities announced a combined $100 million investment in Medically Home to help expand the service to other health systems.

Rakowski said there’s another selling point of the at-home care model — patients don’t have to transfer to a different facility while they heal.

“We stay with the patient until they’re fully recovered and that averages anywhere from 20 to 30 days, sometimes longer,” Rakowski said. “So we substitute not just for the hospital, but for all the care that follows.”

Still, not every patient is a fit. To be eligible for care at home, they must live within 30 minutes of emergency care. They also need high-speed internet and, said Patel, they can’t be too sick.

“This can’t be something where it’s so complicated that you are monitoring a patient, worried that they could crash and need to be in the ICU within minutes,” she said.

But for moderate COVID-19 and dozens of other conditions, at-home hospital care programs now offered in 30 states are likely to become a more common option as more health systems adopt the program and even more diseases are added to those now eligible for at-home care.