Clarice Grote, MS, OTR/L

Hospital Care At Home: The Way Of The Future?

January 2, 2021

Acute Hospital Care at Home (AHCAH) is an innovative healthcare solution allowing hospitals to provide an acute-care level of care in an individual’s home.

What is Hospital Care At Home?

AHCAH started many years ago but grew due to the COVID-19 Pandemic. Johns Hopkins and Mount Sinai pioneered the Hospital at Home model. AHCAH is the next step in an overall goal to transition to value-based bundled care.

AHCAH expressly waives §482.23(b) and (b)(1) of the Hospital Conditions of Participation. This condition requires nursing services on-premises 24 hrs a day, seven days a week. Instead, a nurse is typically available virtually.

Hospital at Home Outcomes

Providing hospital care at home led to reduced cost, improved mobility, and fewer falls than traditional hospital admissions. This model goes by many names such as Acute Care at Home, Hospital at Home, Acute Hospital Care at Home, Hospitals Without Walls, etc.

This program is significant during pandemic times as patients choose to forgo care until critically necessary due to fear of hospitals and COVID-19. This type of hospital avoidance has increased the level of acuity and length of stays for hospitals in a time where bed availability is at a premium.

Not Your Traditional Home Health

AHCAH considers the home as an extension of the hospital. Therefore, there is no need to complete an OASIS or follow the typical Medicare Part A Home Health regulations. The level of care provided in this model is also significantly different. While a patient may only receive a visit 2-3 times a week under traditional home health, a patient must receive two visits a day in this model. Additionally, a physician must make the initial visit in person.

While at home, the patient can receive most of the traditional services they would receive in the hospital. They can still receive electrocardiograms, x-rays, intravenous fluids, RT, OT, PT, SLP, oxygen therapy, etc. Therefore, the level of care provided in a traditional hospital setting can still be provided at home. Although there are many diagnoses where treatment at home would not be appropriate, it is ideal for individuals experiencing an exacerbation of chronic diseases such as COPD, heart failure, diabetes, gout, etc.

Why Hospital at Home Models Need Occupational Therapists

The most natural environment for OT is in the home. As a profession that focuses on function and occupation-based interventions, the home provides an opportunity for practitioners to observe how the individual interacts with their environment during their activities of daily living.

It is impossible to recreate the home environment in the hospital, so the ACHAC model allows OT practitioners to provide acute interventions without wondering if they will carry over after discharge. We don’t have to wonder if the patient will have a kitchen table to organize their medication. We don’t have to wonder how they can complete their laundry or cook their meals upon discharge.

What We Can’t Know in the Hospital

When we see patients in the hospital, it can be challenging to precisely know how patients will do when they return to their natural environment. Patients do well in the hospital rooms with doorways designed for a walker, where they have grab bars and an ADA height toilet, where the hospital bed adjusts up and down and has a handrail on the side.

But, what about when they go home where the hallways are lined with boxes. Or, their walker can’t fit through a door in a home that was built 100 years ago? Do they have safe access to a toilet or clean running water?

I often wonder if my patients with COPD will have enough O2 tubing to get to their laundry. If not, how long until they are readmitted after a fall from low O2 on the steps? Or return because of an exacerbation after they walked to the end of the driveway to get the mail? As home health practitioners, we can directly address these challenges in a meaningful way.

Occupational Therapy’s Value in Chronic Disease Management

Occupational therapy practitioners have a lot of value to add to the hospital-at-home model, especially in integrating chronic disease management techniques into daily routines. We can reinforce education provided by the nurse and physician on medication management, blood sugar checks, O2 safety, etc.

Verbal education is not sufficient. The at-home model allows OT practitioners the opportunity to assess the patient’s functional cognition, safety, disease management skills, and social support accurately and effectively.

Occupational therapy is the only service proven to reduce hospital readmissions in traditional acute-care settings. So, why wouldn’t this apply in the AHCAH model? Occupational therapy practitioners are interdisciplinary practitioners. We use information and education provided by other clinicians and translate that knowledge into action for patients.