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3 Key Questions That Impact Home-based Care Providers in Hospital-at-Home


Article originally featured on Home Health Care News

With COVID-19 increasing capacity challenges in hospitals while also making patients wary of entering, U.S. Centers for Medicare & Medicaid Services (CMS) continues to expand its hospital-at-home waiver program, designed to give hospitals regulatory flexibilities to treat certain patients within their own homes.


Health systems and hospitals are driving this process, but they do benefit from partnerships with home-based care providers — both home health care and non-medical personal care — which bring an expertise around home in the care that hospitals often lack.


To enter and succeed in the hospital-at-home space, hospitals and health systems must answer three key questions, says Dr. Bruce Leff, a hospital-at-home expert, director of the Center for Transformative Geriatric Research at Johns Hopkins University School of Medicine and World Hospital at Home Congress co-chair.


The answers to those questions will show just what kind of role home-based care providers can play.


Getting started: buy or build?

As of March 3, 48 health systems and 109 hospitals in 29 states have been approved under the CMS “Acute Hospital Care at Home” initiative. Yet even if, or when, this waiver program ends, hospital-at-home won’t, as payers and health systems strike out on their own to provide hospital-level care inside the home.

No matter how they enter the space, hospital-at-home providers will need to determine how they will adapt their care model to suit the home space. This is true if they buy a program from a commercial entity, or if they build their own.


“I think the potential advantage of (buying a program) is that the health systems don’t have to build the whole thing from scratch, because it does take a fair amount of effort to build your own,” Leff says. “And by doing so, the adopting health system can leverage the experience of their partner of building out a hospital at home.”


Whether a hospital or health system builds or buys matters to a home-based care provider, because it indicates how much assistance that system needs to get started.

“I think home health agencies can be a valuable partner in helping health systems develop hospital-at-home,” Leff says.


What assistance does the hospital still need?

For hospital-at-home to work, hospitals and home-based care providers need each other. There are elements of providing care in the home that still evades hospital workers, while there are specific clinical capabilities that home health agencies must develop.


“I think most health systems that have hospitals at the core of their business, it’s fair to say that most of those systems have a lack of full understanding of what it means to provide care outside the bricks and mortar of the hospital,” Leff says. A hospital nurse, for instance, might not feel immediately at ease with delivering care in the home; a home health agency can help smooth that transition.


The flip side is true too, though, because skilled home health care is not the same as hospital-level care. The patients are much sicker, and that is an adjustment for home health. Agencies need to be ready for that difference, and must build out their clinical capabilities if they want to partner with health systems. Congestive heart failure, wound care and COPD are all areas where home health needs to improve clinically to be a strong partner in hospital-at-home.


Who can be the right hospital-at-home partner for a hospital?

A home health agency interested in partnering with a hospital for hospital-at-home must know what a hospital is looking for in a partnership. Much of what hospitals need, home health agencies can already provide, Leff says, whether that’s medical capabilities and know-how (pharmacy, infusion therapy, durable medical equipment) or specific care providers, such as therapists or social workers.


The change comes from the workflow.


“Hospital-at-home is a different pace than skilled home health care — a different tempo, a different level of coordination, a different level of safety and quality,” Leff says. “If someone is in the ER and they are being admitted to hospital-at-home and they need infusion antibiotics in the home in a few hours, then they need them in three or four hours and not three or four days.”


This article is sponsored by the World Hospital at Home Congress, which will host its next event on April 19-21, online, allowing professionals from around the world to join the only global platform on hospital-at-home and transform health care together.