For family caregivers, the devil is in the details.
The Hospital at Home model has been around since 1995, but in the time of COVID, it is gaining traction. Hospital at Home gives acute care that would normally be given in a hospital to patients in their homes.
Generally, it includes intravenous therapy (mainly antibiotics), anticoagulation, wound care and chemotherapy that is suitable for in-home care. In the case of pneumonia, it allows nurses and physician assistants to monitor and administer the IV antibiotic. It is paid for by Medicare as if the patient was in the hospital. Technology plays a big role in this model, allowing x-rays, blood work and EKGs to be taken in the home as well. This allows for many common conditions like congestive heart failure (CHF) and urinary tract infections (UTIs) to be treated at home. Chest pain, stroke symptoms, severe abdominal pain or drug overdoses are not eligible.
It sounds great, doesn’t it? After all, who wants to go to the hospital if they don’t have to?
I find so many red flags with the Hospital at Home model, not the least of which is the statistic that gets buried at the bottom of all the benefit lists: “This model will lower care costs by up to 30 percent compared to traditional inpatient care.” I am all for decreasing healthcare costs, but not on the back of family caregivers.
Is it safe?
How would you feel if a lack of training or a misunderstanding resulted in your giving a medication incorrectly? Or a wound procedure resulted in an infection?
The National Nurses United November 4, 2021 press release outlines the danger. “Not only does this program endanger the imminent safety and lives of patients, but it also completely undermines the central role registered nurses play in the hands-on care that patients need to safely heal and recover. The entire reason for being admitted into a hospital is to benefit from the 24/7 monitoring, assessment, and professional care that licensed registered nurses provide. Nurses, more than any other health care staff, spend the most time with patients.”
The dependence on technology.
Technology plays a big role in this model. What does this mean for technology deserts in the U.S.? What about elders living alone who are not able to manage the technology due to eyesight, hearing loss or general confusion around the process?
In some model implementations, the patient receives extended nursing care and daily physician visits in order to determine the best treatments. This tapers off to daily nursing visits based on need. Does the family caregiver have any input into ‘based on need’?
Then there is the Clinically Home model where physicians perform video visits instead of doing house calls. I’m sorry, but it became clear to me during the pandemic that Telehealth has a role, but it does not replace a visit with your physician. I also learned that a 15-minute visit from a nurse to check out the patient does not give the family caregiver enough time for training on what must be done or get questions answered. “Give me a call if you have any questions” is not helpful when it takes a day or two for a call back.
The dependence on family caregivers.
How much of the 30% reduction in costs is because it gets shifted to family caregivers?
Denise Brown of The Caregiving Years Training Academy has been following the Hospital at Home model since the beginning of the year. She raises excellent questions that have yet to be answered.
- “Who will pay, train, support and spell us when we provide critical care at home for our caree?”
- “What support will be available for us when a caree experiences a significant medical event at home while receiving care through a Hospital at Home program?”
- “If you are providing hospital level care at home, something could go wrong that is truly traumatic. Where is the support for the trauma that would be created in the home for such an event?”
The only other group to raise a concern for family members was once again, the National Nurses United.
There are already too many stories of family members being discharged from the hospital with minimal training to the family for care at home. Even when home health is approved after a hospital visit, support and training for caregivers is minimal. Where in the Hospital at Home models is a recognition and plan for the family caregiver? There is none.
If this concerns you, as it concerns me, now is the time to act. A coalition of big-name health centers like the Mayo Clinic, Johns Hopkins Medicine, Kaiser Permanente, UNC Health and others are advocating for continuing Hospital at Home flexibilities beyond COVID-19 with the creation of an advanced-care-at-home delivery model at the Center for Medicare & Medicaid Innovation.
Here are two ways you can be an advocate for yourself and other family caregivers. Denise Brown is collecting stories about the complex care you provide. To share your story, go to: Tell us about the complex care you provide. In addition, you can sign the petition started last spring, Let’s Act Today to Support Family Caregivers.
Please help us be a voice for family caregivers. We are the primary care provider for our carees and the health care system must start paying attention to our needs as well.
Disclaimer: The material in this blog is for educational purposes only. It is not intended to replace, nor does it replace, consulting with a physician, lawyer, accountant, financial planner or other qualified professional.
Deb is available as a caregiver consultant. She will answer the question: “Where do I start?” and find the resources to alleviate your stress. If you would like to invest a half hour to learn how she can help you, please contact her at: Free 30 minute consulting call
Deb is the author of “Your Caregiver Relationship Contract.” This book explains how to have an intentional conversation and the how unspoken expectations can cause problems. Click here to learn more about Your Caregiver Relationship Contract.