Mary Hull, a hospital patient in Albuquerque, cracked a poignant joke that gets to the heart of a healthcare movement whose time seems to have come.
Hull, 43, was waiting for her doctor to do a routine check up, but she was sitting in her living room, comfortable and calm. At home, she was treated with intravenous antibiotics for a skin infection on her leg and abdomen.
X-rays were taken with a portable machine and her blood was being drawn every day. A nurse came by three times a day. She avoided the worry of finding someone to watch her cat, according to the New York Times.
“I’m hoping to be discharged soon,” Hull said. “But I guess it doesn’t matter much. I’m home.”
Similarly, Martin Fernandez, 82, was brought to the Mount Sinai Hospital emergency room in New York with unbearable abdominal pain. Like Hull, the elderly man would need to be officially admitted to the hospital to receive treatment for a urinary tract infection.
But then, much to his surprise, he and his family were asked if he wanted to stay at the hospital or be treated at home. The decision was a classic no-brainer, one you would make in an instant.
His hospital room turned out to be his daughter’s apartment two blocks away, where he got TLC, his favorite foods, wore his own clothes, and comfy pajamas at night. In his shoes, which he also was able to wear, you would be happy to be fed by someone who loves you.
The costs were the same at home as they would have been in the relatively loud and lonely hospital environment.
Hull and Fernandez are just two examples of what some hospital systems are trying to reduce costs while improving quality of care.
It also holds at bay, by working around it, the real threat of infections acquired at hospitals and the dangers they pose, more so to older adults.
About 1.7 million people in the U.S. acquire an infection from being in the hospital, says Washington, D.C. medical malpractice attorney Patrick Malone. “What’s becoming an even more ominous outcome of that experience is post-hospital syndrome — a condition of extreme vulnerability to a variety of health threats to which recently discharged patients are subject,” Malone writes on his blog.
Given the choice, wherever it’s offered, lucid patients want to be hospitalized at home. It can be accomplished even with patients who have severe, chronic conditions. Frank Blondin, 52, who has severe rheumatoid arthritis and heart disease, was treated at home for an infection that caused diarrhea.
His case was handled through Presbyterian Health Care System’s Hospital at Home program in Albuquerque.
The concept isn’t new, having been pioneered by Bruce Leff, MD, in a groundbreaking study 10 years ago. Leff is now director of geriatric health services research at Johns Hopkins School of Medicine in Baltimore.
Leff’s study showed that even elderly patients who needed admission to an acute care hospital for pneumonia, worsening chronic obstructive pulmonary disease and chronic heart failure, and cellulitis could be treated at home.
The study also found that the at-home approach improved the quality of medical care while lowering costs – mostly by shortening hospital stays – a combination that is a huge part of the continuing attempts to overhaul the U.S. healthcare system. As more Americans are given the choice, at-home hospitalization is gaining steam.
Leff believes the at-home concept is still evolving. But, he has been contacted by more than 100 health system executives curious about how the transition can be accomplished. He also sees hospitals of the future providing very specialized, very high-tech care, while the rest of medical treatment returns – essentially – to house calls.
If you live in an urban area, the chances are higher that at-home programs are being offered. That’s because there are simply more hospitals and healthcare systems in urban areas. The American Academy of Home Care Medicine (AAHCM) can help you find at-home services, and you can access guidelines to learn more about how at-home care works.
This at-home movement is indeed expanding as it piles up positive results. But it isn’t necessarily going to keep you out of a hospital.
Patients have to be carefully selected for the at-home option. Some need the constant monitoring only a hospital can provide for conditions that could turn life-threatening in an instant. But as this experiment continues, patients who can be hospitalized at home will become easier to identify.
As the kinks continue to be worked out – such as how to transport equipment and keep medications viable – you may be one of those folks who can receive treatment while you swing happily on your front porch some balmy summer evening
July 10, 2015
Janet O’Dell, RN