Bringing the hospital to the home
A Yale New Haven patient receives care in her house, and it was covered
“These are actually admitted patients who come over either from the ED or from the physical hospital and they’re acute, so it’s not home health, it’s home hospital.” — Stacey Lane, director of operations and administration for the Yale New Haven program
Irene Glavan of Stratford recently recuperated from pneumonia and RSV in her home’s family room, while still a patient at Bridgeport Hospital.
Glavan participated in Yale New Haven Health’s Home Hospital program, which enabled her to receive treatment, have nurses visit twice a day and have the ability to contact the hospital at any time, all from home.
First authorized during the COVID-19 pandemic, the program is helping relieve the crowded conditions at the hospitals, as well as giving patients a more comfortable experience, according to Stacey Lane, director of operations and administration for the program.
At first, Glavan, 75, was skeptical when a nurse asked her to speak to a representative on the phone. She was especially concerned about the cost. It turned out that Medicare covered it just as if she never left the hospital.
“After I hung up the phone, I asked the nurse … is it legit? Is it something that I should be looking into?” Glavan asked. “She said yes. She said it’s really a good program.”
Then she asked her doctor. “She said it’s a program called hospital home care,” Glavan said.
“You go home. You’re still in the hospital. You’re not discharged from the hospital. You’re in the hospital,” she said. “You’re not supposed to leave your home, but we transport you back to your home [by] ambulance, and everything is set up in your home as you are in the hospital.”
Sure enough, when she arrived
home, her family room was all set up, with bins of supplies all ready.
The only thing missing was an IV drip stand when she needed to get intravenous saline. They “rigged up a floor lamp” to hang the bag from, Glavan said.
“There was a nurse waiting for me in my home,” Glavan said. “She said, ‘I’m a nurse for Yale and we set your home up’ and I got in the house and I was amazed. … They had bins, literally bins set up in my house and all the medical supplies in the bins, injectables, they had bandages, they had anything that they needed for blood draws.”
A hospital Wi-fi was set up. “And then it was like a bat phone that I could just pick up and speak to a doctor in a matter of a minute,” she said. “And then they had a monitor. I can Zoom a nurse or a doctor whenever I press the button.”
She also Zoomed in at night to show that she was taking her medications, which were given in individual packets, and that she was using her nebulizer. When a nurse was having difficulty drawing blood because Glavan’s veins tended to collapse, a phlebotomist was called in. Couriers arrived every day to make deliveries and to pick up blood.
Glavan still had concerns about the charges, however.
“I’m thinking, cha-ching, how much is this going to cost?” she said. “Nurses are coming to your home, then you’re doing a Zoom call with doctors. And it was all under Medicare. I got a letter in the mail saying that it was all approved. So that really made me feel even more comfortable.”
Glavan said she was pleased with the program. “I felt more care in my own home than in the hospital,” she said. “My doorbell was constantly ringing because of the courier and then the nurse and then also, on the second day, you have a nurse practitioner come.”
The program, which Yale New Haven launched in June, is available at both campuses of Bridgeport Hospital’s and Yale New Haven Hospital. Lane said they hope to expand the program to Greenwich, Lawrence & Memorial and Westerly hospitals. So far, 246 patients have taken part in the program.
Patients must live within 25 miles of the admitting hospital and meet other criteria, including having a safe house, where there are no threatening dogs or other issues, such as lack of heat or electricity, Lane said. Each patient is screened, both medically and psychologically, to be sure they are good candidates for the program.
The program was approved in 2020 by the Centers for Medicare and Medicaid Services to treat COVID patients at home “related to capacity constraints and the pandemic,” Lane said. “And we did a pilot during that program, but we didn’t do anything official.”
Yale New Haven Health decided to implement its program in June. “These are actually admitted patients who come over either from the ED or from the physical hospital and they’re acute, so it’s not home health, it’s home hospital,” Lane said.
Patients have undergone intravenous antibiotic therapy, wound care, treatment for COVID, cellulitis, chronic obstructive pulmonary disease, congestive heart failure, sepsis, urinary tract infections and other issues, Lane said.
“There’s a lot of things that need to be coordinated to deliver into the home,” she said, including twice-daily nurse visits and visits by a nurse practitioner or physician assistant, who acts as a case manager, on days two and four.
At the hospital, “mission control” keeps watch on each at-home patient, Lane said. “They’re set up in the home with all kinds of equipment, so they have several ways to reach us,” she said.
“They can pick up a phone and it goes right to mission control,” she said. “They have a tablet, where we do our virtual visits from and they can push a button on the tablet. They have a box that they can push a button, and they wear a wrist bracelet that has just a button that goes right to mission control as well.”
If a patient does not respond to a call, a rapid-response team will go out to the house. And if a patient declines, he or she will be brought back to the hospital, Lane said. That’s why the 25-mile limit is important, she said.
“We will want to be able to move them back as quickly as we can, as safely as we can if that happens,” she said. “And we’ve had escalations back to the hospital, but we’ve had great luck with doing this in a safe manner and then getting the care that they need.”
Among the criteria patients must meet are that they be 18 or older, not be pregnant and have coverage with one of the companies Yale New Haven with which has contracted.
If a patient had a different insurance plan and “was really motivated and wanting to be cared for at home, we would probably try to get the insurance company to agree just on a case by case,” Lane said.
“It’s been working out very nicely,” she said.
“We’ve got some great positive feedback from the patients and family members. The nurses are very satisfied with the care that they’re giving. … Our nurses are also from intensive-care units, from the ED. They’re all from the brick and mortar, the physical hospital” as opposed to home health care nurses, Lane said.