UNC Health Talk

Retired Nurse Benefits from Hospital-at-Home Program

Retired nurse Mrs. Gray spent four decades caring for thousands of patients, but last month she was the one in need of care.

The 87-year-old had been rushed to the emergency department for a medical condition that required hospitalization but not ICU-level care, making her a candidate for UNC Health’s hospital-at-home program, Advanced Care at Home.

“Advanced Care at Home is designed for patients who are ill enough to be hospitalized but stable and not in need of critical care services, so Mrs. Gray was a great fit,” says Meera Udayakumar, MD, medical director of Advanced Care at Home. “Despite being very familiar with traditional brick-and-mortar hospital care, she really appreciated the benefits of getting hospital-level care in the home.”

There’s No Place Like Home

Studies show that patients who receive medical care at home tend to heal faster and have better outcomes. For example, they are more active than they might be in a hospital, they are less likely to experience hospital-associated confusion or delirium, and they experience lower rates of 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.

Mrs. Gray is one of those satisfied patients.

“I was so thrilled when they said I could have my care at home. The whole concept, to me, is such a wonderful idea because I have no doubt that if people are able to come home, they’ll heal faster,” Mrs. Gray says.

A Hospital in Your Home

At UNC Health, when patients come to the emergency department, they are evaluated to determine the 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 are then transferred back home, where they meet with an Advanced Care at Home service provider.

“The transport team got Mom to her home and settled into her little den,” says Jane Allen, Mrs. Gray’s daughter. “And there was a team waiting at the house to set up the technology.”

Patients receive all the technology they need for their care, including equipment to monitor blood pressure, heart rate, oxygen levels and weight. A member of the Advanced Care at Home team teaches them how everything works.

“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 so patients can connect with a clinical command center, which 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.

Mrs. Gray isn’t always comfortable with technology but did well with the at-home equipment, says Ja Medlicott, Mrs. Gray’s son. “I like the fact that there were two different ways of accessing the information. One was through the tablet. The other was through the telephone, so if she wanted to call someone and she forgot how to turn the tablet on or she didn’t want to hit the button on the tablet interface, then she could use the phone.”

Nurses perform virtual assessments throughout the day. Patients also have a “talk to my team” button on their tablets, which immediately connects them to a nurse in the command center, functioning as a hospital call bell.

“Your nurse and your doctor are right at your fingertips—whenever you need them,” Mrs. Gray says.

It’s important to note that not all care is virtual. Healthcare providers visit for regular in-person examinations.

“The services that would normally occur in the hospital room are 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.”

Allen says that knowing the schedule of visits ahead of time was beneficial.

“We could see the schedule when people were coming into the home. If that schedule had to change, you were notified,” Allen says. “So, the patient can look up there and say, ‘OK, I have a nurse coming in to do IVs at 11.’ The team was with mom by her favorite spot whenever they needed to be.”

Benefits for Caregivers

Allen is a longtime caregiver, helping various family members with their healthcare for more than 30 years.

“I’ve been with family in every hospital in the Triangle, and the goal is always to get the patient home as soon as appropriate. Sometimes the family is really overwhelmed with how to care for the patient, but this program was wonderful because my mom could safely go home, and we had the support knowing that the healthcare team was continuing to take care of her,” Allen says.

For patients who don’t have the family support Mrs. Gray had, the Advanced Care at Home team tries to meet those needs.

“Mrs. Gray’s family is amazing. I wish all our patients had that kind of support, but in reality, most of our patients have varying degrees of social support,” Dr. Udayakumar says. “If a patient meets clinical criteria for Advanced Care at Home, our team will do a needs assessment to determine what other social support is needed for a patient to be successfully cared for in our program. We do our best to work with and potentially augment what support that patient has at home. Not every patient is as lucky to have that family dynamic.”

Medlicott says that while the technology used to care for his mother at home was impressive, the staff were the game changers.

“The technology is fantastic, but it’s only as good as the staff behind the scenes,” Medlicott says. “When it’s your loved one, that’s what makes the difference.”

On the Road to Recovery

Mrs. Gray was discharged from the program after four days.

“It’s a wonderful program, and people will get better quicker at home because you’re so comfortable where you’re used to being, and there’s just no place like home,” Mrs. Gray says. “The people that came and took care of me were just like family to me.”


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