Americans embrace hospital-at-home care & associated caregiving tasks

Americans across demographic groups found the hospital-at-home care model acceptable, with a majority saying that they had the capacity to perform caregiver tasks like medication management and equipment monitoring, new research reveals.

Published in the Journal of the American Medical Association (JAMA), the study assessed the acceptability of hospital-at-home care and the potential for caregiver burden. The adoption of the hospital-at-home care model proliferated during the COVID-19 pandemic, largely due to the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home.

CMS launched the waiver in November 2020 to support hospitals facing capacity challenges because of rising COVID-19 cases. The waiver allows approved hospitals to forgo certain Medicare conditions of participation, enabling them to provide hospital-level inpatient care in Medicare patients’ homes. As of June 18, 2024, 331 hospitals across 37 states have been approved for the waiver.

The waiver expires at the end of 2024. However, healthcare stakeholders are calling on Congress to extend it for at least five more years.

Thus, University of Southern California researchers sought to understand Americans’ perspectives on hospital-at-home care. They conducted an online survey from August to October 2023, polling 1,233 randomly selected participants aged 20 years or older in the Understanding America Study. The survey assessed hospital-at-home care perspectives across four domains: acceptability, effectiveness, safety, and convenience. The researchers defined acceptability as answering “strongly agree” or “agree” to the statement: “If I had a choice, I would choose to have hospital-level care at home.”

Additionally, survey respondents reported their willingness to perform caregiving tasks.

Of the 1,233 participants selected for the survey, 1,134 completed it. About 24 percent of survey participants were 65 or older, 51 percent were female, 61 percent were White, and 54 percent had no chronic conditions.

The researchers found that the reported acceptability of the hospital-at-home was 47.2 percent. In the effectiveness domain, 55.8 percent strongly agreed or agreed that people recover faster at home than in the hospital. Further, 58.8 percent strongly agreed or agreed with feeling safe being treated at home, and 49 percent strongly agreed or agreed with being more comfortable if treated at home rather than the hospital.

Though many survey respondents indicated they had the capacity to perform caregiving tasks, it varied across tasks. A majority of respondents (82.2 percent) strongly agreed or agreed they would manage medications on a schedule, while 73.3 percent would monitor medical equipment, 56 percent would change intravenous (IV) bags, and 41 percent would change feeding tubes.

Still, researchers concluded that “given [the] acceptability and capacity for caregiver burden in the general population, codifying the waiver and expanding hospital-at-home care should be considered.”

The survey aligns with recent findings showing Americans’ acceptance of the hospital-at-home care model.

The survey released last month polled 1,025 United States adults over 40. Remote patient monitoring (RPM) technology developer Vivalink conducted the survey.

The survey shows that 39.15 percent of US adults said they are very likely, and 45.27 percent said they are somewhat likely to participate in hospital-at-home programs. Of those who had experienced hospital-at-home monitoring, 84 percent reported having a positive experience. Additionally, nearly half (49 percent) of respondents who had participated in a hospital-at-home program found the RPM devices easy to use.

The three primary reasons patients were willing to participate in at-home monitoring were the convenience and comfort of staying at home (46 percent), avoiding infection exposures in the hospital (23 percent), and confidence in RPM (18 percent).