How Can Integrating Mental Healthcare Improve the Hospital at Home Care Model?

Hospital at Home (HAH) is a concept that has been available for many years but was not widely used until recently. The onset of the COVID-19 pandemic — when nearly every hospital was at maximum capacity, short-staffed, and running out of supplies — was instrumental in showing the value of the Hospital at Home care model.

Imagine if those hospitals had more beds, staff, and supplies available for ICU patients, car accidents, cancer treatments, heart attacks, bypasses, gunshot wounds, and elective surgeries such as knee replacements. Most of these emergent and urgent treatments may have been rerouted to other facilities or scheduled into the future to allow for bed and staffing shortages due to the pandemic.

The HAH care model, which allows for personalized care for patients in the comfort of their own homes, is the logical solution for these issues. It has been shown to help healthcare providers generate positive, and even superior, medical outcomes, increase satisfaction among patients and clinicians and improve their operational and financial performance.

Healthcare at home combines digital health and value-based care, changing the concept of the hospital and giving patients more opportunities to receive care at home. Through HAH, medical staff can make a difference in people’s lives by entering the patient’s home virtually and/or physically, obtaining a truly holistic view.

Taking home healthcare to the next level

While physical healthcare typically comes to mind when discussing Hospital at Home, integrating mental healthcare can vastly improve this promising and exciting model. This is increasingly important as research continues to surface, identifying the interrelationship between mental and physical wellness.

Mental illnesses such as depression or anxiety can significantly impact a patient physiologically, from increasing stress hormones and heart rate to lowering one’s inclination to take their prescribed medication. In one study, “People with depressive symptoms often experience higher rates of physical illness, health care utilization, disability, and an increased need for long-term care services.”

An additional study reported that “among individuals with diabetes, total health care expenditures for individuals with depression was 4.5 times higher than those without depression” and that it “is associated with increased health care use and expenditures, even after adjusting for differences in age, sex, race/ethnicity, health insurance, and comorbidity.” Integrating physical and mental health into a sustainable HAH model has significant and long-lasting implications.

How to integrate mental healthcare into Hospital at Home

Assessments for the appropriateness of HAH are typically done in the emergency department. These assessments must include a thorough evaluation of the patient’s mental status and behavioral health history. Compliance with medications also needs to be examined.

Monitoring patients in a HAH setting undoubtedly saves space in a hospital. Research indicates that these models are “effective substitutes for inpatient admissions;” however, the benefits do not stop at the door of the local medical center. Research supports that HAH models are “associated with reductions in mortality, readmission rates, cost, and increases in patient and carer [caregiver] satisfaction.”

Lowering the price of care can be life-changing for many Americans for whom medical treatment is unaffordable. Patients and payers can reap this benefit, as many physical and mental illnesses that can be treated by in-home care may be comorbid or chronic. Chronic illnesses are the most significant Medicare expense, with 82% of older adults having one or more diagnoses.

Additionally, only “20% of Medicare beneficiaries with five or more chronic conditions account for 2/3 of Medicare spending.” Effective HAH management of these chronic conditions can lower the cost of Medicare expenses. On the patient side, significantly lower costs can be expected. In one study on treating acute diverticulitis in a home setting, the “cost savings ranged from 35% to 83%.”

Obstacles to home healthcare

If there are so many benefits to healthcare providers adopting the HAH model, why is this not currently standard practice? While many areas are beginning to look at this as an option, barriers exist for specific regions and demographics.

Does a rural area have enough practitioners to support a hospital and the HAH model? Can practitioners provide care to a diverse group of people? Is there government funding available to help kickstart these models? Can older age groups overcome the stigma surrounding mental health help? Can a patient receive remote care if they do not have access to the internet or high-speed data at home?

HAH models can be beneficial to the future of healthcare. However, obstacles must be addressed, and mental health must seamlessly integrate into physical at-home care to holistically treat the patient. These barriers and many other inequities will need to be reduced or eliminated for this model to be successful across a broad range of markets and individuals.

To learn more about how to build and implement a Hospital at Home system that maximizes your ROI and care outcomes while minimizing obstacles, read our research paper entitled Hospital at Home: Making Home the Focal Point for Care.