It’s often been said that there’s no place like home for comfort. And when it comes to healing, this is sometimes the case, too. Now a new program allows qualified patients to receive expert care – the same quality and services they’d receive in a medical center – in a comfortable setting that supports healing and recovery: their own homes.
Novant Health New Hanover Regional Medical Center began enrolling patients in the Hospital at Home program in March, so the program’s in its early stages. And growing. During the program’s first six months, 52 patients opted to get care at home. The average age of a patient in the program is 78, though patients in their 20s have taken part. Hospital at Home may be less costly than traditional hospital care, and it’s beneficial for patients who are vulnerable to hospital-acquired infections and other complications.
Patients must meet clinical and social criteria established by Centers for Medicare & Medicaid Services (CMS) to be eligible for the program. There are 78 approved diagnoses – including pneumonia, COPD, urinary tract infections and more. Hospital at Home is only available to patients on Medicare or Medicaid, so there’s little to no cost to the patient. Medicare and Medicaid in North Carolina cover Hospital at Home, just as they do hospital stays.
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Initially, Hospital at Home was a result of the COVID-19 pandemic in 2020, when overcrowded hospitals led the CMS to temporarily authorize reimbursement. The authorization allowed hospitals to expand their capacity at a time when many were stretched beyond their limits.
When the waiver expired, Congress extended it through the end of 2024, with a requirement that CMS conduct a study – published recently in the JAMA (Journal of the American Medical Association) – to gauge patient attitudes toward receiving care at home. Researchers surveyed 1,100 participants in hospital-at-home programs. A full 56% agreed that people recover faster at home than in the hospital – and 21% strongly agreed.
Congress is considering extending the program indefinitely. Currently, 322 hospitals in 37 states are approved to provide hospital-at-home care.
High-tech and high-touch
Seven New Hanover Regional Medical Center physicians are dedicated to Novant Health’s program, and they provide care completely virtually. They have backgrounds in family and internal medicine, geriatrics and emergency medicine. There’s also a nurse on call 24/7 in the hospital command center.
Sleep, nutrition and mobility are three key tenets of the program. The clinical team works to ensure patients receiving care at home are getting good sleep and nutrition and can get around the house easily.
“When you’re in the hospital, you're often woken up at night for an assessment or to check vitals,” said Christy Spivey, a nurse by training and senior director of nursing, community hospitals for Novant Health’s Coastal region. “But with the at-home program, if there’s no clinical reason for us to wake you up at night, we say goodnight and agree on what time we’re going to engage in the morning.”
How does a doctor at the hospital say “goodnight” to a patient who’s recovering at home?
Via video chat, naturally.
And what if patients don’t have a computer? No problem. They’re sent home with a loaner tablet so they can readily communicate with their care team. The tablet is a cinch to use – even for someone who’s not tech-savvy. “All they have to do is touch a big, green button on the screen to reach a nurse immediately,” Spivey said.
And that’s just the beginning.
“We send whatever devices a patient needs,” Spivey said. “They can monitor blood pressure, temperature, weight, pulse – we’ll even send a bedside commode if they need it. We teach patients how to check their vital signs. The readings are fed directly into the tablet, so it’s all super easy for the patient.”
The hospital has its own transportation service that takes patients from the hospital to their home. Once they’re back on familiar turf, a community paramedic is dispatched to the home to set up the patient’s virtual equipment. When the patient is discharged, a community paramedic gathers the medical equipment and tablet and returns them to the hospital.
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Family support is key
To be considered for the program, patients must have support at home.
“Patient safety always comes first,” Spivey said. “We screen carefully. If someone lives independently and has no high-risk factors, we could admit them to home if there’s a neighbor or friend to check on them.”
Listening to the patient’s family and friends is crucial. They’re included in the plan of care. “If they notice a change in the patient or have questions, our team is trained to delve deeper,” Spivey said. “If we’re really concerned, we call a paramedic and ask them to check on the patient.”
Patients who receive care at home must first be admitted to the brick-and-mortar hospital. In fact, patients who participate in Hospital at Home are still classified as “inpatients.”
Eating right
When you’re in the hospital, three meals a day are delivered to your room. And they’re all tailored to your dietary needs.
The team ensures at-home patients have access to healthy meals the same way: by delivering them. Getting hospital-level care at home means patients are provided customized meals – three meals a day and for up to three days – from the hospital’s kitchen.
“And these are medical meals,” Spivey said. “If the physician orders a cardiac diet, a low-sodium diet, whatever that diet is, the meals will be compliant with the physician’s orders.”
The paramedic will even go into a patient’s pantry to review its contents and discuss with the patient or a family member which foods are best for them.
Novant Health’s program is different from most because, Spivey said, “Our meals come from our kitchen run by our own food and nutrition team. A courier picks those up and takes them to the home. They’re easy to prepare. You just pop them in the microwave.”
Being able to move freely around the house is as important as proper nutrition. And community paramedics – an invaluable part of this program – are trained on home safety. They’ll do a safety assessment of a patient’s home to ensure nothing impedes their mobility. They look for trip hazards, like throw rugs, that can be eliminated.
“In the hospital, a patient who’s a fall risk isn’t usually encouraged to get up as much as they really should,” Spivey said. “At-home patients are encouraged to get up and move around the house. We do all we can to promote mobility, including providing physical therapists who are specially trained to provide services in the home for those who qualify.”
No place like home
The Hospital at Home team works daily to identify patients who could benefit from receiving care at home. And that’s no longer about easing crowded conditions; it’s about making qualified patients comfortable and getting them back to their normal lives as soon as possible.
Each morning at 7:30, the clinical team huddles to review plans of care for each patient and identify those who would be a good fit for at-home care. Then a Hospital at Home physician works with eligible patients and the physicians caring for them to discuss the program as an option.
“Some are like, ‘Are you kidding? You can’t get me out of here fast enough,’” Spivey said. “Others know that if they go home, the family demands will fall to them. They can get more rest in the hospital. It’s entirely up to each patient.”
Some patients are reluctant to participate. But oftentimes this reluctance goes away as soon as Spivey explains what the program entails. They’re not being discharged; they’re receiving hospital-level care at home.
“All the care they’re receiving in the hospital is exactly what they’ll get at home. We continue the antibiotics, therapy, breathing treatments, whatever they’re getting,” Spivey said.
Patients in the brick-and-mortar hospital with similar diagnoses to those who receive home care have nearly identical lengths of stay. The ideal home stay is three or four days, although some New Hanover patients needed as few as two days of home care. “The longest was 12 days,” Spivey said. “We use the same benchmarks to determine when a patient is ready for discharge from home as we do when they’re in the actual hospital.”
The program is still ramping up. Currently, two or three patients are admitted to Hospital at Home every day. Spivey hopes that number will be closer to 10 by the end of 2024.
“Part of our plan to scale up involves our geographic reach,” she said. “We started small in New Hanover County with one paramedic. In June, we added a second paramedic during the peak hours of 10 a.m. to 10 p.m., which allowed us to expand into Leland. We want to eventually expand to Brunswick County.”
Patients who’ve participated are grateful for the comforts – and convenience – of being at home. Novant Health’s patient satisfaction scores are impressive. “Of the surveys we’ve received, we've gotten 100% positive scores,” Spivey said. “Patients really appreciate being able to recuperate at home.”
If you’re admitted to the hospital, ask your doctor about the criteria for Hospital at Home.
Healing at home
When Gina Aldinger experienced shortness of breath and flu-like symptoms in October 2024, she thought it might be COVID. As a longtime smoker, she was used to having some shortness of breath, so she wasn’t overly concerned. It was about a week before she went to her primary care doctor.
Because she suspected COVID, she couldn’t enter her doctor’s office. A nurse came to her car and checked her blood oxygen level. It was 60. A normal reading would be around 95%. Anything lower than 88% typically requires immediate medical attention.
“They thought the meter was broken,” Aldinger, 64, said. “They kept checking it, and finally, they asked my doctor to come out to my car. He was surprised I’d been able to drive myself to his office. He told his team to call an ambulance because I needed to get to the ER right away.”
EMTs administered oxygen and rushed her to Novant Health New Hanover Regional Medical Center in Wilmington. It was there she learned that what she thought was COVID was chronic obstructive pulmonary disease – COPD.
Aldinger spent two nights being cared for in the hospital.
“The staff was wonderful,” Aldinger said. “I didn’t feel all that sick, even though I was on oxygen the whole time.”
On the third day, Aldinger’s care team sent her home with an oxygen tank. But she wasn’t discharged. Through Hospital at Home, she was still considered an inpatient. Seven New Hanover Regional Medical Center physicians provide care completely virtually, and a nurse is on call 24/7.
The hospital’s transportation service takes patients home, and then a community paramedic is dispatched to set up their equipment. They come home with any medical devices they need and are taught how to check their vital signs. The readings are fed directly into their computer (or a loaner tablet, if they don’t have a computer).
Aldinger was skeptical at first: “When they told me I could go home, I thought it was too soon, but they assured me that somebody would be at my beck and call if I had an issue. I knew it would be easier on my family if I were home. My insurance would’ve allowed me to stay another night, but if I could get hospital-level care at home, that sounded like the best of both worlds.”
Click here to read the rest of Gina's story and meet her respiratory therapist.
