Questions and Answers About “Hospital at Home”

There’s no place like home—especially when you’re sick. In fact, studies show that patients who receive medical care at home tend to heal faster and have better outcomes. That’s why hospitals all over the country, including UNC Health, are beginning to offer some patients the option to receive acute-level care at home for serious conditions such as congestive heart failure and pneumonia.

Meera Udayakumar, MD, is medical director of the UNC Health hospital-at-home program Advanced Care at Home. She answered our questions about this new model of care and why it can be beneficial for patients.

What is a hospital-at-home program?

Hospital-at-home programs such as UNC Health’s Advanced Care at Home are for patients who need hospital care but are able to remain at home and with their loved ones while they receive it.

“It’s hospital care delivered to their front door,” Dr. Udayakumar says.

What are the benefits of receiving care at home?

There’s a growing body of data that patients in the hospital-at-home model fare better. For example, they are more active than they might be in the traditional hospital, they are less likely to experience hospital-associated confusion or delirium, and there is potential for lower rates for readmission to the hospital, Dr. Udayakumar says.

“There is also data that patient experience surveys show very high rates of satisfaction with this model,” Dr. Udayakumar says.

How does a hospital-at-home program work?

At UNC Health, when patients come into the emergency department, they will be evaluated just like they usually are to determine what type of treatment and care they need. If a patient requires hospitalization, he or she may be offered the opportunity to participate in Advanced Care at Home.

Those patients will then be transferred back home where they will meet with an Advanced Care at Home service provider. That service provider will set the patient and family up with all the necessary technology needed for their care and teach them how everything works. Providers will deliver equipment to monitor blood pressure, heart rate, oxygen levels and weight.

“The technology kit is very streamlined,” Dr. Udayakumar says. “It’s intended to be simple and straightforward with no unnecessary equipment, and everything is very user-friendly.”

The kit also has a tablet, which allows the patient to connect with a clinical command center that is staffed around the clock by UNC Health medical staff who can virtually assess and communicate with patients. Physicians also provide virtual visits from the command center.

“Our nurses perform virtual assessments throughout the day,” Dr. Udayakumar says. “Patients also have a ‘talk to my team’ button on their tablet, which immediately connects them to a nurse in the command center, and that functions essentially like a hospital call bell.”

It’s important to note that not all care is virtual. Patients receive regular in-person examinations by healthcare providers.

“The services that would normally occur in the hospital room will be deployed to the home. These include blood draws, radiology, intravenous treatments and physical therapy, just to name a few,” Dr. Udayakumar says. “All of these visits are scheduled with the goal of minimizing interruptions and allowing patients to rest while giving advance notice so family members can participate in the visit.”

How frequent are the in-person visits?

The frequency of the in-person assessment depends on the diagnosis and also the severity of the condition, “but they can definitely expect at least once a day, most likely twice a day,” Dr. Udayakumar says.

What type of patient can use this service?

UNC’s Advanced Care at Home program is for patients over the age of 18 who require hospital admission but not intensive care or step-down care units. Intensive care units are for the most critical cases, and step-down units are between ICUs and general medical floors in severity.

People using the hospital-at-home program “are ill enough to be in the hospital, but not critically ill,” Dr. Udayakumar says.

Also, not all clinical care can be provided in the home. For example, patients who need more intensive services such as immediate surgery would not be able to use the program.

“The Advanced Care at Home medical team works very closely with the physicians and nurses in the hospital to determine if a patient’s needs can be met by our program,” Dr. Udayakumar says.

Is the hospital-at-home program safe?

The program has been designed with safety in mind, Dr. Udayakumar says. That’s why each patient receives a personal emergency response device that allows him or her to immediately connect with a nurse in the clinical command center.

“We also supply a router for strong Wi-Fi and cellular connectivity to the command center no matter where the patient lives, and we provide a power management system with battery backup in the event of a power outage. We’re really trying to account for all of the potential scenarios,” Dr. Udayakumar says.

In addition, outside of the multiple virtual and in-person visits, providers also have the ability to arrange for on-demand visits. For example, a patient might develop a new clinical symptom that needs to be evaluated.

“A patient is not limited to a fixed number of visits, and there is the ability to customize the care for the patient,” Dr. Udayakumar says. “If a patient ever exceeds the level of care that can be provided in the home, we always have the option to transfer that patient back to the hospital.”

Learn more about UNC Health’s Advanced Care at Home program.