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Hospital Care For Serious Conditions Is Moving Into Homes


Hospital care at home is nothing new for patients with low-level health needs, but since the pandemic, a growing number of people with more serious health conditions are getting hospital-level treatment in the comfort of their own homes. Stephanie O'Neill reports.

STEPHANIE O'NEILL, BYLINE: Pandemic isolation finally got to Janet Yetenekian, her husband and two teenaged kids late last year. So in December, when friends invited the Glendale, Calif., family to join an afternoon barbecue, they eagerly accepted.

JANET YETENEKIAN: We just go, OK, we've been home all this time. You know, let's just go a few hours and come back.

O'NEILL: The day after the gathering, the host came down with fever. A test confirmed COVID-19. Within two weeks, Janet's husband and kids got mild cases of the disease, while her blood oxygen plummeted to dangerously low levels.

YETENEKIAN: And a few days later, I had to go to the hospital.

O'NEILL: Treatment included an IV drip of the antiviral drug remdesivir and constant monitoring, things normally done in a hospital. So it surprised Janet when her doctor at Adventist Health offered to move all her care home to be monitored virtually.

YETENEKIAN: It was even better than the hospital (laughter). They were constantly reaching out. It's time for you to do your vitals. It's time for you to take your medications.

O'NEILL: Doctors and nurses at a command center nearly 200 miles away managed Janet's care as part of a new federal effort aimed at freeing up hospital beds during public health emergencies. Under the model, about 60 illnesses, including COVID-19, qualify for home treatment.

MARGARET PAULSON: So heart failure, pneumonia, skin infections - those are all patient populations we can safely care for in the home.

O'NEILL: Dr. Margaret Paulson leads the Mayo Clinic's new home-based care program in rural Wisconsin. Paulson says once her patients understand that home care does not mean less care, they eagerly embrace it.

PAULSON: Especially for patients who have been in the hospital a lot to know that they can actually go home and sleep in their own bed and be with their family and have their pets by their side. It's just really reassuring.

O'NEILL: And studies suggest at-home care provides better outcomes for patients and costs less to provide than traditional inpatient care. Dr. Kavita Patel is a physician and health policy fellow at the Brookings Institution.

KAVITA PATEL: This is actually a higher level of touch from physicians and advanced practitioners.

O'NEILL: Twenty-four-seven monitoring and regular video conferencing is augmented by twice daily in-person visits by nurses and other health workers who provide basic care, such as antibiotics, that can't be given virtually.

PATEL: This isn't just sending, you know, mom or dad to the bedroom.

O'NEILL: Patel says it's the technology infrastructure that's key, including for patients' Wi-Fi phones, iPads and wearable devices with emergency call buttons. Raphael Rakowski is co-founder of Medically Home, the tech company that supports at-home programs for the Mayo Clinic, Adventist Health and others. Another selling point, he says - no facility transfers as patients heal.

RAPHAEL RAKOWSKI: We stay with the patient until they're fully recovered, and that averages anywhere from 20 to 30 days, sometimes longer. So we substitute not just for the hospital, but for all the care that follows.

O'NEILL: Still, not every patient is a fit. They have to live within 30 minutes of emergency care. They also need high-speed Internet. And, says Patel, they can't be too sick.

PATEL: This can't be something where it's so complicated that you are monitoring a patient worried that they could crash and need to be in the ICU within minutes.

O'NEILL: But for moderate COVID-19 and dozens of other conditions, she says, acute hospital care at home, now offered in 30 states, is likely to become a more common option. For NPR News, I'm Stephanie O'Neill.

CHANG: That story is from NPR's partnership with Kaiser Health News. Transcript provided by NPR, Copyright NPR.

Stephanie O'Neill