Health care in the future may not involve a hospital stay.
Thanks to the coronavirus pandemic, keeping patients, especially older adults, out of the hospital is showing positive results at Baptist Health.
Mary Leen, vice president of Clinical Operations for Baptist Physician Partners, along with a team of subject matter experts, developed enhanced home support models to keep patients in a home setting.
Baptist Home Health employs 100 Baptist Health caregivers – nurses, physical therapists, social workers – and outside contract agencies that travel to a patient’s home to administer care.
In 2020, when COVID-19 cases overwhelmed hospitals, Baptist Health devised a plan to care for all but the most serious cases in patients’ homes.
“What was fairly innovative was the speed with which we set it up. We pulled together subject matter experts, developed a protocol and partnered with our home health care agency,” Leen said.
“We rapidly set this protocol into motion so that patients did not even have to access the hospital.”
During the peak, the hospital treated 1,800 COVID-19 patients with about 10% having to be admitted into the hospital, she said.
With the crisis period of the pandemic having passed, Leen said the model has potential for how to treat chronic illnesses.
The best patients for the program are older adults who are somewhat self-sufficient and have a family member living with them or close by to make sure the patient is eating and engaged.
Each case has its own challenges, Leen said.
“If you’ve seen one 90-year-old, you’ve seen one 90-year-old,” she said, indicating that each patient is different.
The reasons at-home care is preferred to a hospital stay are practical.
Many older adult patients prefer to stay in familiar surroundings. Others fear that a hospital stay will lead to living in a senior health facility.
Admission at a hospital changes a patient’s lifestyle, Leen said.
Upon admission, a patient is put into a bed. The longer in bed, the longer the recovery, Leen said.
“If you put a senior in the hospital, your chances of having to go to a skilled nursing facility are much greater,” Leen said.
At home, patients feel they are still in control of their lives, she said.
When possible, the same members of the team treat the patients, creating a relationship of trust.
That is important because older adults are more likely to tell a nursing professional about changes in their condition than they are to tell a family member, Leen said.
The Enhanced Home Support Model does not install hospital monitoring machinery in the home. Nurses make sure that medication is dispensed and that blood pressure, blood sugar, oxygen levels and other vital measurements are taken.
Physical therapists work on range of motion and mobility.
Social workers play a role as well.
“We pay particular attention to the social determinants because we are well aware of the inequitable distribution of resources,” Leen said.
“If a patient has one need, says he can’t afford the cost of an antibiotic, they generally can’t afford something else.”
Leen expects hospitals to adopt home health care as the norm as the general population continues to age and live longer.
“Health care cannot always be within brick-and-mortar hospitals,” she said.
That was the business model for hospitals for many years. Leen said placing home care as a priority may not have found a place on a hospital board’s agenda as few as five years ago.
“COVID provided that tailwind of innovation. Once we saw what we could do with COVID we asked how many other people can we keep out of the hospital?” she said.
“We use hospitals when we need to, but health care cannot be confined to a hospital.
