Hospital care at home is about to explode in New Jersey
Delia Halpin was being treated for a lung infection at Hackensack University Medical Center over three days in July when doctors came to her room with a suggestion: You can go home if you’d like.
Halpin, 80, wasn’t being discharged. She was returning to her Maywood house with a load of medical equipment, a tablet to let her keep in touch with doctors, and a team of nurses who would visit every day until she recovered.
“No one wants to be in the hospital,” she said. “It was great to be home, be around family, be around the things you’re comfortable with.”
Halpin is among the first wave of patients who received care under Hackensack’s new “Hospital from Home” program — but she is far from the last.
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Born out of the COVID-19 pandemic, this new way of providing care is expected to spread quickly among New Jersey hospitals thanks to a new law that greatly expanded the number of patients eligible for these services by requiring all private health insurers to cover them.
“You’re going to see care continue to shift to home in a big way over the next few years,” said Kristin Bloom, an assistant vice president overseeing Virtua Health’s Hospital at Home program in South Jersey. “You can’t ignore the benefits and the outcomes that you see.
“The health care industry will not be able to sleep on this,” she said.
Health care providers have been looking at alternative ways to care for patients as they deal with a current staffing crisis and an expected tsunami of older patients who will likely require greater care in the years and decades to come. The number of New Jerseyans over 60 is expected to increase by 1 million this decade when those in the tail end of the baby boomer generation become senior citizens.
Patients with early-stage infection, chronic heart or lung disease
Each hospital has its own protocols, but typically a patient is identified for hospital-at-home programs almost immediately when they are brought into the emergency room, or a few days after they are admitted. A number of boxes need to be checked before a patient is able to participate. Are they well enough to be treated at home? Do they live in a stable home? Do they live with a caretaker?
The most common ailments among those sent home at Hackensack and Virtua are early-stage infections or pneumonia, along with those whose chronic heart disease or chronic lung disease has flared up, doctors said.
Patients arrive at home with a monitor that transmits all their vital signs in real time to a command center staffed mostly by nurses. Other common equipment includes IV pumps, oxygen tanks and a tablet for telehealth sessions. Nurses come at least once a day to check on the patient.
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“If we can bypass any brick-and-mortar care, we will going forward,” said Dr. Jason Korcak, an internist who oversees the program at Hackensack. “In-hospital treatment is necessary for many people who come through our doors, but at the end of the day you’re still in a hospital. The missing piece is the comfort of their own bed or family by their side day and night.”
COVID sparked ‘Hospitals Without Walls’ program to free up beds
Receiving care at home is nothing new. It harks back to a time when the neighborhood doctor made house calls carrying a black leather bag. And it has evolved in recent years mostly to long-term elder care at home, hospice care, and visiting nurses and physical therapists checking in on people recently discharged from a hospital.
But providing full acute services at home wasn’t done extensively until the pandemic. In the spring of 2020, as COVID spread like wildfire in New Jersey and the rest of the Northeast, the federal government launched the “Hospitals Without Walls” program to free up beds and reduce the spread of coronavirus in hospitals.
Most patients have been seniors, since Medicare was the only insurer to cover the costs — until recently. A few notable hospital networks across the U.S. have begun using it extensively, including Mount Sinai Health System in New York and Massachusetts General Hospital.
About a dozen New Jersey hospitals have been approved by federal regulators to provide home services that were covered almost exclusively by Medicare.
‘Hospital at Home Act’ requires medical coverage
But last year, Gov. Phil Murphy gave a jolt to these programs when he signed the “Hospital at Home Act” into law. It ordered private insurance companies, NJ FamilyCare and Medicaid programs to provide coverage for hospital services delivered at home “on the same basis as when services are delivered within the facilities of a hospital.”
The patient pool has expanded greatly now that insurance coverage is no longer limited to those 65 years and above.
Doctors say they have seen benefits for patients in and out of hospitals. Patients sleep much better at home. The risk for infections usually associated with hospital goes down. “It’s virtually nonexistent,” said Dr. Diego Ortega, lead physician for Virtua’s Hospital at Home program.
Meanwhile, more hospital beds are available for the sickest patients, and demand for care goes down at a time when staffing is a major problem at medical centers.
“It frees up a lot of capacity, especially during the flu and respiratory illness season,” Ortega said. “It also frees up staff. Doctors and nurses can now spend more time with the sickest patients inside the brick-and-mortar hospital.”
Not every case works out. About two or three of the 50 Hackensack patients who have received care at home since late April have had to go back to the hospital after taking a turn for the worse, said Korcak, the internist. Virtua Health, which has treated 1,100 patients at home since 2022, has had a 4% readmission rate this year, Bloom said.
Truck arrived with oxygen machine, tanks, IV equipment, monitors
Among those who stayed at home was Delia Halpin. She had the sort of living arrangement that the staff at Hackensack liked to see before allowing a patient to go home. Her husband and an adult son lived at home with her and were capable of lending a hand in her care.
Her house was big enough that a spot could be carved out in the living room where she could rest instead of having to climb stairs.
A truck arrived at her home with an oxygen machine and tanks, along with intravenous equipment, health monitors and a tablet to connect to doctors and nurses around the clock.
In the mornings she would contact a nurse on the terminal and go over her vital signs. A nurse would come in later in the day and examine her, including scanning her kidneys to see if they were functioning correctly. She received virtual visits from her doctor. “I always felt safe because I knew someone was near,” she said.
About a week later, Halpin was “discharged.” Workers took away the medical equipment, and she was given an itinerary of follow-up visits, medication and preventive tips as if she were being wheeled out of the hospital.
Halpin said she recovered much faster than she would have in the hospital.
“I’m not the most active person, but I don’t want to just lie in a hospital bed for days doing nothing,” she said. “I was at home. I could get up if needed. It was where I wanted to be.”
NJ hospital systems approved for home care
- Holy Name Medical Center.
- Cooper University Hospital.
- Virtua Health.
- Hackensack Meridian’s JFK University Medical Center, Hackensack University Medical Center and Jersey Shore University Medical Center.
- Salem Medical Center.
- Jefferson Health.
- Carewell Health.
- Inspira Health.
Source: Centers for Medicare and Medicaid Services
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