In your own bed: Kansas City hospital launches a new way to avoid hospital stays

Nestled in a plush recliner, in front of a 58-inch TV, with her husband of 57 years close at hand in their Grain Valley living room, 88-year-old Delores Saunders proclaimed: “Well, this is my hospital.”

Instead of doctors being paged over a squawking intercom, a golden clock above the fireplace played music at the top of the hour by the 1970s soft rock band Bread.

To her left, tissues, a TV remote, a pack of gum and grocery store coupons cluttered a table that her husband, Lee, jokingly called the “pile.” There was also an iPad on a stand.

Tapping a button on the screen, Saunders, or her husband, could connect in seconds, 24/7, to a nurse in a medical command center at Saint Luke’s East Hospital, 13 miles away.

In September, when she couldn’t stop coughing, her family rushed her to the hospital, where she was diagnosed with pneumonia. But instead of putting her in a hospital bed for several days, Saint Luke’s asked if she’d rather recuperate at home.

Saunders, who had sextuple coronary bypass surgery in 2004, couldn’t pass up the chance to sleep in her own bed.

She is one of the early patients in Hospital in Your Home, a new hybrid program of virtual and daily in-person care offered by the Saint Luke’s Health System — and hospital-at-home movement growing nationally.

It’s available to certain patients, ones who are clinically stable, who would otherwise need to be hospitalized for serious illnesses and problems related to chronic diseases such as congestive heart failure and chronic obstructive pulmonary disease. They receive the same level of care at home they would get in the hospital, hospital officials say.

But one major difference: They can have their pets by their side, a popular perk.

Hospital in Your Home is only available to patients at Saint Luke’s East. But officials told The Star they will begin offering it at Saint Luke’s Hospital of Kansas City in January.

The hospital says this is the first program of its kind in the Kansas City area. The area’s major hospital systems, including University Health, AdventHealth, Olathe and The University of Kansas Health System, confirmed they have no such program. KU has been tracking in-home programs and continues to evaluate them, a KU spokeswoman said.

But many other health systems across the country are using such programs and interest is growing, in part because hospitals see the “gray tsunami” of baby boomers heading their way.

The Mayo Clinic, for instance, launched its Advanced Care at Home program in July 2020 during the pandemic when telemedicine took off, though the service had been planned before COVID-19 came along. Saint Luke’s has partnered with Medically Home, a Boston-based virtual health care company that also works with the Mayo Clinic.

“I think we were heading in this direction anyway,” said Dr. Michael Nassif, medical director of the Saint Luke’s program. “It just makes so much sense for older patients to stay in a comfortable environment where they’re far more likely to be (walking) around the house, not catching hospital-acquired infections, not laying in bed getting debilitated.

“COVID I think gave us a 10-year-boost forward. I think it would have been here anyway, but I think COVID expedited that pathway a lot.”

Treating patients at home leaves hospital beds available for more critically ill patients as hospitals struggle to find space. Nassif estimated that between 7% and 10% of all patients admitted to Saint Luke’s East could qualify for Hospital in Your Home.

If those beds open up at a hospital that is full most days of the week, he said, “that’s an enormous victory for the health system which has been bursting at the seams for the last two years almost continuously.”

And, according to the American Hospital Association, providing at-home care costs 25% less than an in-hospital stay.

As of last week 102 patients have been admitted into the St. Luke’s program since July 19.

Some patients are so excited to recover at home that Nassif has to remind them that they will still be under hospital care, even when they’re lying on their sofa. They can’t make a Target run. This is not a get-out-of-the-hospital-free card.

“No matter what, we’re in the home twice a day,” Nassif said. “We have instances where we’ve been physically in the home five or six times a day. We’re able to provide quite a bit of resources.”

The menu of at-home services is lengthy. IV infusions. Lab work. Physical, occupational and speech therapy. Mobile imaging and ultrasounds. Specialty consultations.

Saunders spent her nine days in the program listening to audio books with her earphones on, “so she can cut me off altogether,” her husband joked.

How it works

Margo Banks was the first to sign up, a 73-year-old with congestive heart failure who went to the Saint Luke’s East emergency room in July when she became short of breath. Her doctor had urged her for more than a week to go the emergency room, but Banks, like Saunders, is no fan of hospitals.

She had been hospitalized six times in the past two years, so she was afraid if she went to the ER she would be admitted. She was right. But then Nassif made her an offer she didn’t refuse: the Hospital in Your Home program.

“Sign me up,” Banks said.

She especially liked that being at home would make it more convenient for her family to visit.

“I live five minutes from my daughter and grandkids. The hospital is 30 minutes from my daughter and grandkids. It’s so hard for them to try and get over there, and I don’t want them to because I know it’s a problem,” she said.

By the time Banks got home, an iPad and two paramedics from her care team were waiting for her.

The average age of the patients in the Saint Luke’s program is 80, Nassif said. Some have been nervous about all the technology. The iPad. The medical alert bracelet they wear in case they fall or have another emergency.

Much of the equipment is powered by Bluetooth — the pulse oximeter, blood pressure cuff, bathroom scale. Vitals are taken several times a day, in person, like they are in the hospital.

“Currently we are just tracking weight, their oxygen saturation, heart rates and blood pressures,” said Nassif, a cardiologist. “In the very near future, we’re talking to a couple of different companies on the best way to track heart rhythms. Some patients who have arrhythmias that are still relatively low risk we can keep at home and be able to watch their heart rhythm 24 hours a day.

“Remote monitoring is an exciting field. We’re looking into a couple of small pilots to monitor how much fluid is inside somebody’s body, or fluid inside of their lungs.”

Like Saunders, about half of the patients in the Saint Luke’s program have congestive heart failure, Nassif said.

“The big question we ask ourselves with each case that comes across, is there anything that they’re going to do in the brick and mortar hospital that we could not do in the home. And usually that has to do with any invasive procedure or any advanced imaging.,” said Nassif.

The program has also admitted “some very sick patients with cancer who were having infections,” said Nassif. He told those patients that the same antibiotics they would receive intravenously in the hospital could be administered at home.

“And they’ve been more than willing to do that, especially if you can imagine a patient with end-stage cancer. They don’t always have a lot of days at home left.”

The Mayo Clinic started its at-home program with patients with similar diagnoses — heart failure, COPD, cellulitis, bladder infections — but quickly broadened the scope.

“We started looking at post-operative care, so that if you got a surgery and you usually spend five days in the hospital, maybe you just spend the first day in the hospital and once you’re stable you go home and get your post-operative care there in the home,” said Dr. Michael Maniaci, an internist and medical director for Care Anyplace programs within Mayo’s Center for Digital Health.

Mayo has treated five bone marrow transplant recipients at home who would have typically spent 15 to 20 days in the hospital. But on day two they got to leave and “spend the next two to three weeks at home getting their transfusions and infusions and IV antibiotics and labs,” said Maniaci.

“Most of these patients just sat around the hospital not doing a whole lot. They just sat there from a safety standpoint and needed certain care aspects that couldn’t be delivered before. Now we can do that in the home setting.”

At-home programs are not designed for patients who are clinically unstable, need ICU care or who need rapid surgery, an advanced procedure or repeated imaging. “Those folks, because their care is back and forth so much, they don’t qualify for the program, today,” said Maniaci.

“Now, once they stabilize, day two, three, four, they can come into the program. But you don’t want to get somebody in the home and then rush them back for a blood transfusion, an emergent surgery, anything of the sort. Clinical stability is kind of No. 1.”

Most of the patients in the Saint Luke’s program are seniors. But the Mayo Clinic’s program is available to any patient over 18.

“We don’t do kids yet at Mayo though I know other programs are looking at children,” said Maniaci. “That’s a big forefront that I think will be popular because kids hate being in the hospital, parents hate being away from their children.”

Nassif and Maniaci see the programs as just the first step away from business-as-usual for hospitals. But insurance coverage is a challenge, since most private payers do not cover hospital-level care in the home, according to the hospital association. Most of the patients are covered by Medicare or Medicaid.

“Basically we’re decentralizing medicine. We’re taking it away from the traditional silos, a hospital, a clinic, an imaging center and we’re spreading it throughout the community,” Maniaci said.

“Because the problem with medicine nowadays, we keep investing in a system that is broken. There are these centers of excellence where people can go, but they’re miles and miles away from people without the means to get to them … and their health suffers because of it. And it’s not their fault.

“So the only way to fix that is to decentralize medicine and spread it throughout the community with these care bubbles of all of these wandering care providers directed through command centers and such, so we can get the care to the people who need it.

“We’ll always need hospitals. People will need surgery, they’ll need intensive physical therapy or some sort of invasive procedure. But there’s not enough hospital beds on the planet for the aging population of the United States or this world.

“So we have to find something else besides spending all our money building buildings, and this is the way to really reach the most people wherever they may live.”

The rehab-nursing home cycle

One of the worst outcomes for a patient with a chronic illness, Nassif said, is becoming debilitated and falling into the cycle of hospital-then-nursing-home.

Data shows that 5% to 10% of even ambulatory Medicaid patients in their 80s and 90s will wind up in a skilled nursing facility or acute rehab after spending a week in the hospital, said Nassif.

But that’s not happening with Hospital in Your Home patients.

“I’m crossing my fingers and knocking on wood when I say this, but to date we’ve had zero patients, even though we’ve had a patient who is 80 and 15 or 16 in their 90s, go to acute rehab and we’ve had none go to a skilled nursing facility. I think that’s been the most exciting outcome for us,” Nassif said.

One likely reason: Patients are more mobile at home.

“In the hospital you’re up maybe an hour, at best two hours a day, just to go the bathroom or get up out of bed to sit in a chair, really not much more,” Maniaci said.

“Here they’re in their homes, they’re up moving around, eight, 10 hours a day. People are walking all over the place. They’re in their kitchen, they’re on their couch, they’re sitting outside.”

Happy patients

Saunders liked being able to sleep in her own bed, eat her own food, not waiting for someone to respond to a call light when she had to go to the bathroom — because you don’t keep an 88-year-old bladder waiting.

“Just being here, I mean, I’m in my chair that my children bought me. I can relax in it. I can set myself up in it. I can listen to my tapes. I get tapes from the library. I can listen to those,” she said from her recliner. “I can watch my own TV. You might see that I have a large TV because I am really legally blind.”

Clinical studies of at-home programs have found they can lower mortality rates and the risk of a rehospitalization and, well, make patients happy.

“It’s a side joke that we have a literal home court advantage,” Nassif said, “because when a patient has slept for eight or nine hours, I think they truly do heal faster and they truly do better.”

And they are kept accountable, Maniaci said.

“Often we send people home from the hospital and it’s like, did they fill their meds at Walgreens, did they make their follow-up appointment? We don’t know. We just kind of send them off and you hope for the best,” said Maniaci.

“Whereas here you can actually check them. Hey, you had your cardiology appointment on Tuesday, Hey, Walgreens says you haven’t picked up your prescriptions, you need to have somebody come by and pick those up and drop them off. You individualize this care and that’s the intimate experience.”

Chief cook and bottle washer

Lee Saunders called Hospital in Your Home “probably the best thing that anybody could come up with, for the patient. It’s the caretakers that have to be on the short end of the stick.”

When his daughter called the house, he would answer, “Head nurse.”

He’s been his wife’s main caregiver for years as her health has declined. Having her at home while she recuperated from pneumonia added to his daily duties, like calling the command center on the iPad to have someone check her medication deliveries.

“It’s a lot of work, on top of being everything else in the house, chief cook, bottle washer, laundry man,” he said.

Offering more support to caregivers is a growing issue that the health care system must address, with or without hospital-at-home programs, Maniaci said.

No one is forced to participate. If a caregiver, for instance, does not want to be involved, a home health aide could be assigned. But the majority of caregivers and family members want to participate.

Lee said he appreciated the team of people helping his wife and wished they could stay in the house 12 hours a day.

“One of the most important things about this program is the education that the caretaker gets,” he said, noting how he knew very little about the medications his wife has taken for years. “What I’ve learned in doing this is incredibly valuable.”

His wife, who was discharged from the program in late September, had a difficult time saying goodbye to the team of nurses sitting 13 miles away in front of computer screens at Saint Luke’s East.

“In a brick and mortar hospital, nurses spend a lot of time handling logistics,” said Nassif. “With our model, they spend very little time handling logistics and just much more time actually seeing the patient and talking with the doctor and the family.”

Cassandra McGinley was one of Saunders’ virtual nurses.

“I’m going to be perfectly honest with you,” McGinley said. “I’ve been a bedside nurse for 22 years and I struggled with remembering my patients’ names, in all honesty, because we went through so many every day, every month. And I would know them more by room number and diagnosis.

“Whereas in this program I know Delores, I know Margo, our first patient. I know their names, I know their families’ names. I know their home. I know their dog’s name.

“It’s on such a more personal level. So many times when it’s time to discharge our patients, they don’t want to see us go. They’re kind of sad.”

McGinley said some patients try to think of reasons to stay in the program. But that’s really not the point of hospital-at-home.

“We always say we’ll take you back,” McGinley said, “but we hope we don’t have to.”