Like other patients in the newest “wing” at Kent Hospital, Gwendolyn Zangari’s room has all the comforts of home.  It should: it is her home.

“I can be with my own husband, have my own food, my own bed,” she explains.  “A hospital stay is frightening; being at home has been a blessing.”

This is precisely the goal of the Kent Hospital at Home program, which brings full-scale inpatient care at home. It is the first program of its kind in Rhode Island, and only the third in New England (with both of the others located in Boston).

“It’s the same standard of care that patients would receive with a traditional hospital stay, entirely within the patient’s home,” says Dr. Michael Lee, the Kent HaH Medical Director.  “We’ve already seen enhanced patient recovery rates, and it helps free up beds in the hospital to prevent overcrowding, so it’s a win-win.”

Not all patients qualify for the program; Lee says that candidates must be “sick but stable,” meaning that they are unhealthy enough to require an in-patient admission, but unlikely to need any sudden medical intervention.  This typically restricts eligibility to patients with chronic, rather than acute, disorders, with respiratory ailments (including pneumonia, COPD, and asthma) being among the most represented.

Within 15-mile radius

Patients also must live within a 15 mile radius of the hospital’s Toll Gate Road campus, although Lee notes that this does not form a perfect circle.  “It reaches a little further to the south than the north,” he explained.  “We want to make sure that we are the closest hospital to the patient in case they need to be taken in quickly.”

While “admitted,” patients were a unique bio-feedback patch which allows doctors to provide constant monitoring of vital signs and other key diagnostic information.  They are seen by doctors at least once a day, in addition to two daily visits from nurses.  These visits often last longer than traditional room calls and give the patient a better chance to get to know the clinicians caring for them.

“One of my favorite things about the program is the way that it combines cutting-edge medical technology with the classic medical tradition of the house call,” said Lee.  “It’s like taking the best elements of the old school and the new.  Many patients might remember an era when the doctor did come to their house, and many of them will tell me ‘I can’t believe this has come back!’”

House calls

“The look on their faces when they see a doctor entering their home is amazing,” he added.

According to Dr. Lee, elderly patients have constituted the majority of the roughly 100 patients admitted to the program since its inception; he says that the program has 3-6 patients at any given time.  The program is administered as though it were a traditional wing of the hospital, with two permanent doctors and five to six nurses, with additional staff assisting on a rotating basis. 

Beverly Grimshaw is just one of the patients to experience that amazement.  In December, symptoms of congestive heart failure led the 87 year-old to call emergency services.  Traditionally, this would have resulted in an inpatient admission for treatment and monitoring.  Through the Hospital-at-Home program, however, Grimshaw has been able to receive treatment from her house in North Kingstown, with her son Gregg Grimshaw assisting during her convalescence.  “Being at home has helped her heal that much more quickly,” Gregg said.

For her own part, Beverly recommends Hospital at Home to any eligible candidate considering it.  “Nobody needs to second-guess when the doctor tells them about this program,” she said.  “It’s top notch.”

Pandemic played a role

Dr.  Ana Tuya Fulton, the program’s founder, cites Grimshaw as a perfect example of the type of patient this program was designed for.  “One of the target populations of patients we take care of in these kinds of programs is older adults, like Beverly,” she said.  “As a geriatrician, to be able to offer acute hospital-level care at home for our older adults who prefer it, after years of seeing the adverse outcomes of multiple transitions of care for older adults, is amazing.  Care at home is the future, and the Kent team looks forward to building this option and sharing lessons learned with other systems of care, both local and national.”

That future can be traced back to technological and administrative changes brought about by the recent pandemic.  “What really made this possible were the changes to insurance billing caused by Covid,” Lee said.  “When Medicare started allowing hospitals to ‘admit’ patients that were not physically in the building, it let us start finding ways to expand our treatment options.”

This was accompanied by the various telehealth technologies which emerged over the course of the quarantine, giving clinicians additional tools for long-distance evaluation and monitoring of patients.  “We can keep track of their vitals, detect if they’ve fallen, order medications to be delivered,” said Lee.  “We have a dietary option available as well for patients who would like the hospital to send over meals, but that doesn’t seem to be a huge demand.”

Avoiding hospital food is just one of the benefits of the HaH program; Lee says that patients typically sleep better in their own beds as well, with the additional rest further boosting recovery rates.  Remaining at home also minimizes patients’ risk of encountering hospital-acquired infections, such as MRSA.

“We have a lot of patients who hear about the option and immediately jump at the chance,” Lee said.  “We’ve even had some who have been in and out of the hospital for years with readmissions who have said that they’ve always been waiting for a program like this.  But we also have patients who feel safer having medical staff immediately available around-the-clock.  It comes down to a personal decision, but for the patients who want it, Hospital-at-Home can make the whole experience a lot more comfortable.