What Families Can Expect From a Hospital-at-Home Episode

This guide helps older adults, family caregivers and clinicians understand what a hospital-at-home episode involves. It explains the hospital's role, how family circumstances can affect fit, and what reported outcome comparisons mean.

Know what the hospital is providing

Hospital at home allows a hospital to provide hospital-level care to certain patients in their homes. Chartis explains that this arrangement would normally conflict with a Medicare and Medicaid condition requiring 24/7 availability of in-person nursing care.

For a family, start by asking which hospital is responsible for the episode and what its hospital-at-home program covers. That gives everyone a concrete point of reference for discussing the proposed care.

Ask how the program handles the condition

A New Jersey Department of Health memo says the CMS hospital-at-home program identified 60 acute care conditions that can be treated at home with proper monitoring and treatment protocols. The number describes conditions identified for the program, not a promise that every person with one of them can receive care at home.

Ask the hospital team to explain how the older adult's condition fits the program and what monitoring and treatment protocols apply. Record the answer alongside the name of the hospital responsible for the episode.

Discuss whether home care is feasible for this family

A study of older patients and caregivers receiving hospital-at-home or hospital-at-nursing-home care for respiratory infections found that both were generally viewed as positive alternatives to hospital admission. Overall satisfaction was high, while feasibility depended on the physical and emotional circumstances of patients and caregivers.

That makes the patient's and caregiver's circumstances part of the fit discussion. Families can describe what support they can provide and what feels manageable, and raise concerns with the treating doctor while care options are being discussed.

Read the outcome comparison carefully

A study of Medicare beneficiaries comparing hospital at home with traditional inpatient care found lower in-hospital mortality and lower emergency department use within 30 days of discharge for the hospital-at-home group. It found no significant difference in hospital readmissions within 30 days of discharge.

These are comparisons between groups of Medicare beneficiaries. They give families and clinicians context for a discussion, but they do not predict what will happen to an individual patient.

Put the episode discussion in writing

Practice owners and clinicians can give families a one-page summary to fill in during the discussion: the responsible hospital, the condition and protocol being considered, and the patient's and caregiver's concerns about fit. This turns the program's role and the family's circumstances into concrete topics for the conversation.

For a decision about an individual older adult's care, discuss the options with that person's doctor.

"HaH and HaNH were generally seen as positive alternatives to hospitalisation, although feasibility depended on patients' and caregivers' physical and emotional circumstances. Overall satisfaction with care was high."

Pepping RMC, Vink I, Roos R, van Aken MO, van den Bos F, de Loor GD, Borgdorff H, Vos RC, van Nieuwkoop C., Hospital-at-home and beyond: experiences of patients, caregivers and general practitioners with out-of-hospital care for moderate-to-severe lower respiratory tract infections in older adults, a qualitative study

This page is general education only. It is not medical advice. Talk with your own doctor about your health.

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