For some patients, receiving medical care in a hospital can be unfamiliar, stressful and even scary. Combining hospital-level medical care with the ability to recover in the comfort of home, Hospital@Home and the program’s team of community paramedics are giving new opportunities for patients to get the professional care they need in a safe, familiar environment.
Hospital@Home medical director Dr. Chrisanne Timpe and director Tia Radant talk about the program, including how it works and the patients it’s perfect for. By sharing success stories, as well as impressive statistics, the directors describe how the involvement of community paramedics is charting a new course for effective and inclusive health care. Listen to the episode or read the transcript.
Hospital@Home – what it is and who it’s for
As Dr. Timpe describes it, Hospital@Home is “hospital-level care, but in the comfort of someone’s home.” Patients who receive care are those who would normally be receiving it in a brick-and-mortar hospital. Instead, Hospital@Home brings “the medications, the durable medical equipment, the clinicians (and) the expertise to the patient in their home.” Or, as Tia describes it, Hospital@Home is “a virtual unit … like an extra floor of the hospital, and every room on that floor looks like someone’s living room.”
Hospital@Home, however, isn’t for everyone. “We don’t bring an intensive care unit into your home,” Tia clarifies. “We don’t bring a surgical suite into your home, but a lot of patients who spend time in a physical brick-and-mortar hospital are in a bed being cared for by a team and have a physician that makes daily medical decisions for that care. And that part can be replicated in the home.” In other words, many patients that are safe at home and can get up and care for themselves, but still need hospital-level care, are great candidates for Hospital@Home.
Success stories and statistics
During the episode, Dr. Timpe says that those who benefit from Hospital@Home the most are “people with any sort of sensory deficit, so dementia, blindness, hearing loss and physical disability. People who have learned to adapt to those challenges in their community and thrive in their homes tend to do really well in this program because they can receive their acute care and not be denied the freedoms of living their life the way they’d like to.”
For a real-life example, instead of placing someone with an infection who was completely blind in an unfamiliar hospital environment, they were able to recover in their own home. Since they knew where everything was and could confidently perform daily tasks, they were more active while feeling safer and more engaged – which led to a healthier outcome faster.
Hospital@Home has also proven to be a better option for those with dementia. As Dr. Timpe describes, “in the past, when they’ve been hospitalized, the outcomes have been pretty dire. People will become deconditioned because they’re not allowed to move around as much.” Disruptions to sleep cycles and increased agitation can result in “what should have been a 48-hour stay for an infection (to turn) into a week’s stay … trying to unravel a delirium that is really detrimental to a patient’s overall (health). Instead, Hospital@Home allows patients with dementia to recover safely, calmly and quickly.”
And while that’s just the beginning of the program’s real-life examples of success, there’s also objective proof of Hospital@Home improving the health of its patients. According to the Center for Medicare & Medicaid Services (CMS), from 2020-2023, programs like Hospital@Home have contributed to lower readmission rates and significantly lower transfer rates of the elderly to skilled nursing facilities (1.2% for at-home hospital care to 20% for brick-and-mortar hospital care). That’s in addition to zero hospital-acquired infections, no pressure ulcers or bed sores, and only two minor falls across over 900 Hospital@Home admissions since the program started.
The role of community paramedics
The key to the success of Hospital@Home is the involvement of community paramedics. With a more expanded scope of practice from standard EMS paramedics, the Hospital@Home community paramedic team has training on what Tia calls “life triage” – chronic disease management, needs assessment, social determinants, navigating care and more. Along with their emergency expertise, these additional skills make it possible for the team’s paramedics to also see priorities and situations from the patient’s viewpoint, helping them access the resources and items patients need, including clinical care, medical equipment and community assistance.
Through the pandemic-era public health emergency waiver that helped to create the Hospital@Home program, paramedics are being acknowledged as more than caregivers during ambulance transport. Now, they are also seen as acute care providers that are valuable partners to nurses and hospital staff.
As Tia tells it, “five years ago, I’m not sure how many hospitalists knew what a paramedic really was, much less a community paramedic … so we have this really neat dynamic where the EMS medical director still provides medical direction to the paramedics, but the daily care decision making is a partnership between the paramedic and the hospitalist … there’s a lot of great professional development that comes from this, and I fully expect to see it grow.”
To hear more about Hospital@Home, including how the program got started, its success for patients with congestive heart failure, the high levels of job satisfaction for program caregivers and more, listen to this episode of Off the Charts.
