Delia Halpin had been receiving treatment for a lung infection at Hackensack University Medical Center for three days in July when doctors visited her room and offered her the option to go home if she wanted.
Halpin, 80, wasn’t released from the hospital. She was expected to return to her Maywood home with a trove of medical equipment, a tablet to keep in touch with doctors and a team of nurses who would visit her daily until she recovered.
“Nobody wants to be in a hospital,” she said. “Being at home, with my family, surrounded by comforts was great.”
Halpin was among the first wave of patients treated in Hackensack’s new “hospital at home” program, but she will certainly not be the last.
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This new way of delivering care, born out of the COVID-19 pandemic, is expected to rapidly spread to New Jersey hospitals thanks to a new law that significantly increased the number of patients who can receive these services by requiring all private health insurers to cover them.
“Care will continue to shift significantly to the home over the next few years,” said Christine Bloom, assistant vice president who oversees Virtua Health’s hospital-at-home program in southern New Jersey. “The benefits and outcomes cannot be ignored.
“The health care industry is not going to sit back and let this happen,” she said.
Healthcare providers are exploring alternative ways to care for patients as they deal with the current staffing crisis and a tsunami of older patients who will require more intensive care in the coming years and decades. New Jersey’s population of people aged 60 and older is expected to increase by 1 million this decade as the last of the baby boomer generation becomes seniors.
Early infection, patients with chronic heart or lung disease
While each hospital has its own protocols, patients are typically identified for the Home Health Program shortly after being taken to the emergency room or a few days after being admitted. Before patients can participate, they must meet several criteria: Are they healthy enough to be treated at home? Do they live in a stable home? Do they live with a caregiver?
The most common illnesses seen among patients being discharged at Hackensack and Virtua are early infections, pneumonia and those with worsening chronic heart or lung conditions, doctors said.
Patients arrive at home equipped with monitors that transmit all of the patient’s vital signs in real time to a nurse-led command center. Other common equipment includes an IV pump, oxygen tanks, and a tablet for telemedicine sessions. Nurses come in at least once a day to check on the patient’s condition.
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“If we can avoid brick-and-mortar care, we will continue to do so,” said Dr. Jason Korczak, an internist who oversees the program in Hackensack. “For a lot of our patients who come to us, inpatient care is necessary, but at the end of the day, they’re in the hospital. What they’re missing is the comfort of their own bed and a family member to be there for them day and night.”
“Hospital Without Walls” program launched to free up beds amid COVID-19 pandemic
Receiving care in one’s own home is nothing new — it harkens back to the days of the neighborhood doctor carrying a black leather bag — and in recent years has evolved primarily to long-term elderly care in the home, hospice care, and nurses and physical therapists visiting patients just released from the hospital.
But providing full acute care services in the home wasn’t widely practiced until the pandemic hit. In the spring of 2020, as COVID-19 spread rapidly through New Jersey and other parts of the Northeast, the federal government launched the “Hospital Without Walls” program to free up beds and reduce the spread of coronavirus in hospitals.
Until recently, most of the patients were elderly, because Medicare was the only insurer willing to cover the cost. Several prominent hospital networks across the country, including the Mount Sinai Health System in New York and Massachusetts General Hospital, have begun to use the system widely.
About a dozen hospitals in New Jersey are approved by federal regulators to provide home care services, which are covered almost exclusively by Medicare.
The “Home Hospital Law” requires medical insurance
But last year, Gov. Phil Murphy shocked those programs by signing the Hospital at Home Act, which mandated private insurers, New Jersey FamilyCare and the Medicaid program to cover hospital services provided in the home “on the same basis as if the services were provided in a hospital facility.”
With insurance coverage no longer limited to those aged 65 and over, the patient base has expanded significantly.
Doctors say they’ve seen benefits for both inpatients and outpatients. Patients sleep much better at home. There’s also less risk of infection typically associated with hospitals. “The risk is virtually zero,” said Dr. Diego Ortega, chief physician for Virtua’s hospital-at-home program.
Meanwhile, demand for treatment is falling at a time when more hospital beds are available for the most seriously ill patients and staffing shortages at medical centers are a major problem.
“It gives us a lot of breathing room, especially during flu and respiratory seasons,” Ortega said. “It gives us more breathing room for staff, so doctors and nurses can spend more time with the sickest patients in the hospital.”
Not every case works out: Of the 50 Hackensack patients treated at home since late April, two or three have had to return to the hospital because their condition worsened, said Dr. Korczak, the internist. Virtua Health, which has treated 1,100 patients at home since 2022, has a readmission rate of 4% this year, Dr. Bloom said.
Trucks arrived carrying oxygen machines, tanks, IV equipment and monitors.
Among the patients who stayed at home was Delia Halpin, whose living arrangements Hackensack staff wanted to check before sending patients home: Her husband and adult son lived at home with her and could help care for her.
Her house was big enough that she was able to find a place in the living room to rest without having to go up the stairs.
A truck arrived at her home loaded with oxygen machines and cylinders, IV equipment, health monitors and a tablet to keep her in touch with doctors and nurses around the clock.
In the morning, she contacted a nurse at the terminal who checked her vital signs. The nurse came back later that day to examine her and scan her to make sure her kidneys were functioning properly. She had a virtual visit from her doctor. “Knowing someone was nearby always gave me peace of mind,” she said.
About a week later, Halpin was “discharged” after staff removed her medical equipment and wheeled her out of the hospital in a wheelchair. She was given a follow-up schedule, medications and prevention tips.
Halpin said she recovered much faster than she would have if she had stayed in hospital.
“I’m not a very active person, but I didn’t want to just lie in a hospital bed for days doing nothing,” she said. “I was at home. I could get up if I needed to. That’s where I wanted to be.”
New Jersey hospital system approves in-home care
Holy Name Medical Center. Cooper University Hospital. Virtua Health. JFK University Medical Center at Hackensack Meridian, Hackensack University Medical Center, Jersey Shore University Medical Center. Salem Medical Center. Jefferson Health. CareWell Health. Inspira Health.
Source: Centers for Medicare & Medicaid Services
