The six biggest challenges of the Hospital at Home care model

  • December 21, 2023

The COVID-19 pandemic forced the healthcare industry to reinvent itself in many ways. Whether it was hospitals being stretched past capacity or healthcare providers scrambling to deal with a shortage of staffing and supplies, there were plenty of disruptions to the way healthcare is delivered.

No change was more apparent than the rise of home healthcare. Hospital-at-home, which enables patients to receive personalized care from healthcare providers in the comfort of their own homes, solved many of the issues that arose during the pandemic. It has also been shown to help maximize revenue and generate better medical outcomes, while increasing satisfaction among both patients and clinicians.

However, hospital-at-home also comes with its own unique set of challenges, such as the many underlying technical and operational requirements for extending high-level care across a distributed network. How will you precisely staff, deliver and monitor each patient? What happens if something goes wrong?

Our years of experience helping healthcare providers accelerate their digital transformations has shown six factors that organizations must consider when adopting a hospital-at-home model of care:


The value and overall ROI obtained from the hospital-at-home model has led many health organizations to spend more resources to improve their home healthcare capabilities. However, there are also some concerns on the financial side when adopting these solutions.

For example, upper management at healthcare organizations may view inpatient admissions as being better for revenue, and thus be unconvinced of the value of hospital-at-home. However, when health systems operate under risk-based models, home healthcare becomes a lot more financially viable.

The Centers for Medicare and Medicaid Services (CMS) has made it even easier for organizations to adopt hospital-at-home due to Medicare and Medicare Advantage programs that reward value over volume. Reimbursement through risk-based contracts or through the CMS wavier program, combined with the cost savings associated with acute care at home, can outweigh the cost of running the program and improve the financial performance of hospital-at-home solutions.


Healthcare is a highly regulated industry, and home-based care is no exception. An innovative at-home program must consider collaboration with CMS and audit organizations by seeking approval and setting up program requirements for patients and staff.

Stringent requirements may result in a great deal of resources necessary to audit quality and safety of programs. Privacy and security concerns related to patient data, consent, and documentation also come under heavy regulatory scrutiny.

Standards set by CMS for home healthcare programs include diagnoses considered for admission, additional admission requirements, and home safety requirements. Program requirements must also be met, including matching all the services of traditional inpatient care. It is essential that providers practice continuous monitoring to ensure the program is meeting standards and will not be shut down.


Staffing shortages due to nurses experiencing burnout from long hours and overfatigue are a growing trend in healthcare today. Hospital-at-home helps to alleviate this by giving caregivers better flexibility and more diverse work environments.

However, staffing for home healthcare programs requires special consideration. In addition to traditional hospital staff, the program needs team members to orchestrate care delivery, evaluate patient’s homes for admission, and deliver prescriptions and meals, just to name a few. Buy-in from leadership and current staff is critical to program recruiting and staffing efforts.

Healthcare providers must upskill staff to meet the needs of patients in the home care environment, while providing training for cases with higher acuity and emergency care. There is a current labor shortage for both inpatient clinics and home health agencies, which is why health organizations should emphasize strategies for recruitment, training, capacity planning, and even outsourcing if necessary.


While there are many benefits to providing care to patients in the comfort of their homes, there are also situations where hospital inpatient care is clinically more appropriate and yields better outcomes. Healthcare providers must develop requirements and guidelines for admitting patients to determine whether hospital-at-home or traditional inpatient care is the best course of action.

When hospital-at-home is the prescribed route, providers must ensure that the care at home meets or exceeds the standard of care in any inpatient facility for each diagnosis considered for admission. To deliver high-quality care in a home environment conducive to healing, requirements must be established, technology and services must be coordinated, and outcomes must be measured and tracked.

Providers can ensure that these standards are being met by using remote patient monitoring devices and dispatching nurses and ancillary service providers to the home in addition to telehealth visits with physicians. By following CMS guidelines and employing the right technologies to orchestrate care delivery, providers can achieve positive clinical outcomes.


Social factors that affect any hospital-at-home program include ensuring health equity across all demographics, assessing the patient’s home environment to see if it is suitable for delivering the required care, and ensuring the safety of both patients and staff.

Any healthcare provider implementing an at-home program must consider the patient perception of quality care, standard quality measures throughout program maintenance, and safety of all stakeholders involved. By creating standards and establishing a safety council, many social concerns will be mitigated.


Finally, there must be sufficient technology to support the home healthcare experience. Hospital-at-home operations will require a wide range of remote and portable clinical devices, high-speed data connectivity in the home, and more, all while maintaining strict compliance with security and regulatory standards.

For best results, a hospital-at-home solution must be able to seamlessly offer two primary functions: a logistics command center, and a clinical monitoring capability. Cutting-edge technologies such as NTT DATA’s Home Care Command Center, SMART Analytics, and industry leading integration can be leveraged to enhance the at-home care experience.

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.

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Dr. Richard Swafford
Dr. Richard Swafford, PhD, has more than three decades of diversified experience in the Information Technology (IT) field. He has extensive senior leadership experience in departmental management, network engineering and integration, using multiple platforms for a wide variety of projects. Task development, management, strategic planning, business process reengineering and organizational performance experience are among his broad range of skills and capabilities. Rich has held leadership positions in commercial, healthcare and Department of Defense (DOD) communities.

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