Hospital Visits: When Family Isn't At Home

The 'hospital-at-home' trend is becoming increasingly popular, allowing patients who are sick enough to be in hospital but stable enough to be at home to receive treatment at home. However, this shift has also resulted in family members becoming caregivers, taking on significant responsibility for the patient's care. While this trend has the potential to benefit both patients and their families, there is limited data on the impact of this model on caregivers. There are concerns about the strain and distress caregivers may experience, and there is a need for more attention and support for them. Federal policymakers are considering adding rules to clarify caregivers' responsibilities and ensure they are well-informed and prepared for their role.

Family caregivers take on a lot of responsibility

The 'hospital-at-home' trend has seen family members become caregivers for their sick relatives. This experimental healthcare program is for patients who are unwell enough to need hospital attention but stable enough to be cared for at home. While it has been a blessing for some, it has also raised questions about the responsibility placed on family caregivers.

The Centers for Medicare & Medicaid, which oversees these programs, is considering adding rules to clarify caregivers' responsibilities. According to CMS chief medical officer Lee Fleisher, "CMS makes it very clear that during the hospital-at-home stay, hospitals are not to use family members, support persons, or caregivers to provide care that would otherwise fall to nurses or other hospital staff during an inpatient admission." This means that caregivers should focus on the patient's emotional needs and overall well-being throughout the healing process.

Despite the drawbacks, the 'hospital-at-home' trend has been a positive alternative to hospital stays for many families. It allows patients to be in the comfort of their own homes while still receiving the medical attention they need. It also saves healthcare dollars. However, it is important for families to carefully consider the responsibility they are taking on and to ask plenty of questions before making this decision.

Hospital-at-home programs may be cheaper for families

Hospital-at-home programs are becoming an increasingly popular alternative to traditional hospital care. These programs are designed for individuals who are sick enough to require the attention that a hospital provides, but stable enough to be cared for at home. Research suggests that these programs can provide good care and save on healthcare costs.

While the outcomes of hospital-at-home programs are not yet conclusive, they show promising results in terms of cost savings for families. One of the main reasons that hospital-at-home programs can be cheaper is that they eliminate the need for high-cost procedures and extended hospital stays. For example, in the case of Lori Girard's father, who had chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF), the hospital-at-home program allowed him to avoid a potentially costly emergency room visit.

Additionally, hospital-at-home programs can reduce costs for families by providing remote patient monitoring, daily telehealth visits, and in-person care from nurses. This combination of remote and in-person care can help to identify and address health issues before they become more serious and expensive to treat. For example, the Mayo Clinic's remote patient monitoring program for patients with COVID-19 had a high engagement rate and significantly reduced emergency department visits and hospitalizations.

Furthermore, hospital-at-home programs can be customized to meet the specific needs of patients and their families. For instance, under a traditional care model, a patient with coronary artery disease, COPD, and diabetes might be admitted to the hospital and then discharged to a skilled nursing facility. However, under a hospital-at-home model, the patient could be evaluated by a physician and sent home, where they would receive tailored services such as remote patient monitoring, daily telehealth visits, in-person nursing care, and meal deliveries.

Despite the potential cost savings, it is important to consider the responsibilities that family caregivers may take on in a hospital-at-home program. Family members providing care may need to be prepared for the time commitment and emotional demands of overseeing a critically ill person, even with the support of visiting clinicians. It is recommended that families ask plenty of questions and fully understand the implications of participating in a hospital-at-home program before making a decision.

Family members may not be equipped to provide care

Hospital-at-home programs are becoming an increasingly popular option for patients who are sick enough to need hospital attention but stable enough to be cared for at home. However, this raises concerns about whether family members are equipped to take on the role of caregivers.

Family caregivers often have no prior caregiving experience and are unpaid and untrained. They may not have the necessary skills and knowledge to provide the level of care required by a critically ill person. This responsibility can be overwhelming, especially when coupled with the emotional stress of having a loved one in a vulnerable state.

In addition, family caregivers may have their own lives and commitments, such as work or other family obligations, that can hinder their ability to provide consistent and uninterrupted care. They may also have their own health issues or limitations that need to be considered.

Furthermore, the home environment may not always be conducive to providing the level of care needed. For example, if the family lives in a rural area, it could take up to 30 minutes for a nurse or paramedic to arrive in an emergency, which could have dire consequences.

While hospital-at-home programs can provide good care and save healthcare costs, it is crucial to recognize that family caregivers may not be equipped to handle all the responsibilities and challenges that come with providing care for a critically ill family member. It is a decision that needs to be made on a case-by-case basis, taking into account the specific circumstances and capabilities of the family members involved.

Caregivers should focus on the patient's emotional needs

The 'hospital-at-home' trend has seen family members become caregivers for their sick relatives. This trend has been described as one of the fastest-growing experiments in American healthcare. It involves treating patients at home who are sick enough to need hospital attention but stable enough to be cared for at home. While this trend has the potential to provide good care and save healthcare costs, it also raises questions about the readiness and capability of family members to take on the role of caregivers.

Family caregivers often have no prior caregiving experience and are unpaid. They may struggle with the responsibility of overseeing a critically ill person, even with the support of visiting clinicians. It is important to consider the consequences for these caregivers, who may be unprepared for the physical and emotional demands of caregiving. This is especially true in rural areas, where medical assistance may be up to 30 minutes away, causing additional stress and anxiety.

Despite these drawbacks, many caregivers have found the 'hospital-at-home' trend to be a blessing, as it allows their loved ones to remain in the comfort of their own homes. It gives them a sense of being at home and can be a positive experience for both the patient and the caregiver.

It is important for caregivers to prioritize their own emotional well-being as well. Caregiving can be emotionally draining and stressful, so caregivers should seek support from family and friends or support groups. They should also make time for self-care and practice stress management techniques to ensure they are emotionally equipped to support the patient's needs.

Patients may be discharged without a caregiver

The discharge process from a hospital begins before the day of discharge, with hospital staff and coordinators constantly reassessing a patient's needs for when they are discharged. The aim is to ensure that everything is in place so that the patient can be discharged when a doctor gives the go-ahead. It is the responsibility of the hospital staff and the discharge coordinator to make sure that the patient is ready, that it is safe, and that the patient will have everything they need when they get home. While it is the hospital's responsibility, they will do this with the patient and their family, so there may be some preparation needed before discharge.

The hospital discharge process is a critical time for the patient and their family. It can be a time of anxiety, especially for elderly patients who live alone or need after-care and support. Their safety and well-being are at the heart of the hospital discharge process. When a doctor decides that a patient no longer needs medical treatment in the hospital, there should already be a plan in place for their swift and safe discharge. The hospital's aims are that the patient is ready to leave, they will be safe where they are going, and that any further support is put in place.

In some cases, patients may not have a caregiver or family member to support them after discharge. This can be due to various reasons, such as living alone, having a strained relationship with family, or having family members who are unable or unwilling to provide care. In such situations, alternative arrangements need to be made to ensure the patient's safety and well-being. This may include arranging for professional caregivers or social services to provide the necessary support.

In the United States, the Centers for Medicare & Medicaid oversees hospital-at-home programs, where patients receive medical care at home instead of in a hospital. While these programs do not allow family members to provide care that would typically be provided by hospital staff, they do involve family caregivers in the decision-making process. This ensures that patients and their caregivers understand the responsibilities and implications of the program.

To ensure a smooth transition and adequate support for patients without caregivers, hospitals can take several steps. Firstly, they can facilitate effective communication between the patient, their family, and the healthcare providers. This includes providing clear and timely information about the discharge process, the patient's condition, and any specific needs or instructions. Hospitals can also offer resources and support groups to help patients and their families navigate the challenges of post-discharge care. Additionally, hospitals can coordinate with community organizations to provide transportation, meals, counselling, and respite care services. By involving social services and conducting care needs assessments, hospitals can develop comprehensive care plans that address the patient's physical, emotional, and practical needs.

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