Is it right for you or your loved one? How the “hospital at home” program works, where it’s available, and which patients are eligible.
The small, downtown Vancouver condo Rajiv Mohan shares with his wife and two daughters is filled with all the things you’d expect: a couch for watching TV, a kitchen table for family meals, and the bedroom where he sleeps.
But there are also items most homes don’t contain: intravenous drip bags for antibiotics dangling from a medical pole, an oxygen saturation monitor, and a large box of colour-coded pill bottles labelled Providence Health Care.
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That’s because after Mohan was admitted to St. Paul’s Hospital for a serious ailment, he was sent back to his condo, where he was cared for by a team of health care workers as part of Providence’s new hospital-at-home program.
“I’m better here than in the hospital,” said Mohan, wearing a standard hospital bracelet that identified him as a patient even though he was dressed in regular clothes sitting in his own living room.
When he was admitted to St. Paul’s with sepsis, an acute condition caused by an infection, Mohan was at first unsure about taking part in the voluntary program.
But he was also worried about picking up a hospital-acquired infection from his sick roommate and about his family members who kept an round-the-clock vigil by his bedside.
“Previously, we were a little hesitant. So when they explained everything, we thought it was nice to get home,” said Mohan.
“I’m in my home environment. I’m getting my home-cooked food. I’m with my wife, with my children. The nurses are cooperative, the doctor is a phone call away.”
Mohan, 62, is diabetic with high blood pressure, and was fighting a persistent fever when he arrived in the emergency room on June 13. He returned to his condo two days later and was treated there for 11 more days until he was discharged from the hospital-at-home program, and from St. Paul’s.
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Patients like Mohan who meet Providence’s eligibility requirements receive daily visits from nurses who use car shares to commute. virtual or in-person monitoring from doctors and other health care workers, blood pressure and other vital sign assessments that are shared electronically with the hospital, all medical equipment required for recovery, and a 24/7 line to call staff about questions and concerns.
When Postmedia visited his condo, Dr. Janice Menezes was there to listen to his heart, monitor his sugar levels, and generally check on how he was managing at home.
Mohan, she said, was a good candidate for the optional program because he lives close to St. Paul’s, has family to help him, and was medically stable.
“We can do almost everything here,” Menezes, a geriatric and internal medicine doctor, said while standing in Mohan’s residential highrise building.
And if hospital-at-home patients need to return to a bricks-and-mortar hospital, they can avoid the chaotic emergency department and get seen right away, she said.
That was a key worry Mohan’s daughter, Aanchal, wanted clarified before bringing her dad home: “If his condition worsened, would he have to face long delays to be seen in the hospital?”
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While Mohan and his family were happy with the resources the program offered, it is not for everyone.
“If people are having difficulty due to mobility issues, cognitive issues … then sending someone home to that environment when they’re already not coping is not a good plan,” Menezes said.
“So we have to get people that have family support or are independent. They are cooking their own meals, they’re sleeping in their own bed, they’re getting to the bathroom on their own — all those things that in the hospital you might get assistance with.”
Hospital-at-home was launched by Providence in January, and has so far provided care to 107 patients from St. Paul’s and Mount Saint Joseph hospitals. At the same time, Vancouver Coastal Health started similar programs at Vancouver General and UBC hospitals, treating 100 patients as of the end of June.
“We can offer the same level of care, but to patients who are staying in the comfort of their homes, and we can make them better there,” said Dr. Iain McCormick, VCH’s hospital at home lead.
Both health authorities require eligible patients to live in a safe home environment with access to a phone and a fridge. The most common diagnoses for participants are congestive heart failure, pneumonia, chronic obstructive pulmonary disease, sepsis and bacterial infections.
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Providence requires patients to live within a 15-minute drive of St. Paul’s, while VCH accepts candidates anywhere in Vancouver.
The hospital at home concept is not new. It has been offered in Alberta and Ontario for more than five years, and in the U.S., the U.K. and Australia for two decades.
In B.C., Island Health was the first out of the gate in 2020 and since then has expanded the program to three hospitals and treated 2,400 patients. Northern Health followed in 2021, providing care at home for 925 patients from the region’s main hospital in Prince George.
Fraser Health does not have a full hospital-at-home program, but opened a virtual psychiatric unit in September 2022, which has helped 365 patients. The health authority is planning a second virtual unit, but provided no other details; both Eagle Ridge Hospital in Port Moody and Surrey Memorial have been mentioned as possible hospital-at-home sites.
Interior Health does not have hospital at home program, but is “exploring” the idea.
While this model won’t work for more complex patients, it should help reduce the time they languish on stretchers in overcrowded hospital hallways waiting for a bed on a ward.
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“It frees up a bed for someone else,” said McCormick. “It’s helping the system, and it’s doing that without having to build a new (hospital) tower.”
Provincial hospital-at-home funding has grown significantly from $2.1 million in 2020-21, when Victoria General Hospital launched the first program with only nine patients. By 2023-24, the province pledged $32 million to treat up to 93 patients from several hospitals.
By next March, the ministry hopes to expand that number to 145 British Columbians who can be admitted to hospital but receive full medical care in their homes.
That is a drop in the bucket, of course, compared to the number of people crowding B.C. hospitals.
However, the ministry says it has already saved more than 27,000 “bed days” — every day a bed is free for another patient because someone is being treated at home — since the program was launched in 2020.
Whether this has helped to reduce record high emergency department waiting times is not yet known, due to “the complexity of the system,” the ministry said.
Some patients have worsened while at home, McCormick said, but medical staff were able to respond quickly to those complications to keep them stable. That includes treating people who caught pneumonia while convalescing from another ailment, or those on blood thinners who developed a – blood clot.
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Not everyone is comfortable remaining at home after a medical scare. One patient who fainted asked to return to VGH to be closer to staff who could provide more immediate care, he said.
McCormick and other experts, though, say that doesn’t happen very often. Of the 925 Northern Health patients accepted into the hospital at home program, for example, less than 4.5 per cent needed to return to in-hospital care due to changing care needs, a spokesperson said.
The staff dedicated to the VCH program can care for eight to 10 patients at a time, but McCormick expects that will expand: International hospital at home programs, he said, indicate about five per cent of hospital patients could be a good fit for the model.
“VGH is a 1,000-bed hospital, so I think the true number of patients who we could look after in a VGH hospital-at-home program would probably be about 50,” he said.
In Island Health, hospital at home is now offered to patients at Victoria General, Royal Jubilee and, as of April, Cowichan District Hospital. An independent medical review of B.C.’s longest-running program, published in 2023, found that most participants rated it positively, although some families thought how it worked and their roles as caregivers could have been better explained.
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In Fraser Health, eligible patients from any of the region’s hospitals can seek mental health care from their homes through the virtual psychiatry unit. The health authority says 96 per cent of participants so far have rated their experience as excellent or good.
“People often make a better recovery in their own surroundings, and staying in the hospital longer than necessary can have a detrimental effect on their condition and independence,” said Fraser Health spokeswoman Krystle Landert.
When asked why hospital at home was not duplicated across the province more quickly, the Health Ministry said in a statement that there was much to learn from Island Health’s inaugural program, such as how health care teams could work in a home environment, managing medications, communications with patients and families, and being sure any expansion was “as safe as or safer than hospital care.”
The British Medical Journal reported in May that England’s National Health Service hoped to slash waiting times for emergency care by expanding virtual health services, predicting that doing so could avoid 178,000 hospital admissions over the next two years.
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There are different programs in other parts of the world that are also designed to keep patients out of hospitals by caring for them at home. The U.K. has a service that sends an ER doctor to some ambulance emergency calls, and has found that 85 per cent of patients treated this way don’t need to come to the hospital afterwards.
When asked about these ideas, the Health Ministry noted B.C. has specially trained paramedics directing 911 callers with mild ailments to primary care clinics rather than taking them to emergency. The B.C. ambulance service estimates 350,000 calls a year are for non-life-threatening issues, such as minor wounds, sprains, muscle strains, or skin conditions.
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Hospital at home nurse Silvia Nobrega said her daily visits to VCH patients include the same services she would provide to those in traditional hospitals, such as head-to-toe assessments, medication education, IV infusions, wound care, and blood work.
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In addition, patients are provided with equipment and taught how to use it so they can daily test their own blood pressure, oxygen saturation, breathing and temperature. The results are sent electronically to the hospital, where they are monitored by staff who usually follow up with a phone call to the patient.
Colleagues will accompany her depending on the patients’ needs: dietitians who can teach caregivers about food requirements, occupational therapists who might assess whether patients can reach the bathroom while using a walker, as well as physiotherapists, social workers and pharmacists.
“We create the same resource team as in the hospital, which is needed because these are patients with acute care needs,” Nobrega said.
“The patients can reach a nurse 24 hours a day. We provide them with a virtual call bell where they just need to press a button and it comes straight through to the nurse.”
Most participants told her they would volunteer for the program again if admitted to the hospital in the future.
“They felt safe in their home,” Nobrega said. “They get to sleep in their own bed. And I think, most of all, just (prefer) being home with their families, caregivers and their pets.”
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Hospital at home is innovative, agreed B.C. Nurses’ Union president Adriane Gear, though she added the health authorities need to do a good job of ensuring patients’ homes are safe working environments for nurses: Is anyone using illicit substances? Do they have a dog who bites? Are there family members with behavioural problems?
Home visits should, ideally, be clustered within close proximity so that nurses, who are in short supply in B.C., don’t waste too much time driving to appointments, she added.
And Gear said assessing patients to ensure they are stable enough to be treated at home must be done accurately, as some nurses worry about getting patients back to the hospital should they start to decline quickly.
“I know, in theory, these patients don’t have to go through emergency, and that’s great, but the reality is hospitals are busting at the seams. And so I think that could be a concern,” she said.
Menezes, the Providence hospital at home doctor, said medical staff have been erring on the side of caution with the new program, responding quickly if a patient appears to be deteriorating.
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“Just because they’re home, the care should not be less,” she said.
Participants still wear their hospital bracelets at home, so if they return to hospital for an emergency or for scheduled tests, such as X-rays or ultrasounds, they will be treated as an already admitted patient, not someone who showed up in the waiting room, Menezes said.
At first, some people were reluctant to volunteer for the program when asked by Providence doctors and nurses, but demand is growing and Menezes would like it to expand beyond the seven patients it can take right now.
He cited the example of a cancer patient in his 40s who cried when told he could be treated at home for a serious infection, rather than stay in a hospital room with strangers.
“We took care of the patient, in his home, while spending time with his family, meeting his son who loved to show me his Rubik’s Cube skills,” Dick said during a speech in April.
“It creates the opportunity for us as providers to rethink how we deliver care. We’re no longer bound by the walls of the hospital.”
VCH’s McCormick also cited examples of when being at home is better than the hospital.
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An 88-year-old patient with severe congestive heart failure, difficulty breathing and pneumonia became delirious while waiting on a stretcher for a hospital bed. A worried McCormick suggested he go to his house, where he was put on oxygen, given medication intravenously and was with his family.
“It’s been just a wonderful outcome, and it proved to us that we could take on very severe cases that normally require a lot of physician discretion,” he said. “It just benefits people so much to be able to heal at home.”
Mohan felt well cared for by the nurses and doctors who checked on him in person and by phone.
It meant there was more work for his family, who had to help feed and care for him at home, but that was better than spending days and evenings with him in a hospital room, said his daughter Aanchal.
When the family had any questions or concerns about their dad’s condition, she got answers by phoning the program’s 24/7 support line, she added.
“He was very much uncomfortable on a hospital bed,” said Mohan’s wife, Sharmila. “He was not sleeping there and he was so frustrated. Here, he’s happy. I’m very much thankful to this program, and to the nurses and to the doctors.”
For more health news and content around diseases, conditions, wellness, healthy living, drugs, treatments and more, head to Healthing.ca – a member of the Postmedia Network.
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