Not all patients are appropriate for the Hospital at Home model. The model works best for those patients who meet the validated eligibility criteria and who are motivated to receive their care at home. At the Portland VA Medical Center, the Program at Home nurse and/or physician see the patient in the hospital prior to her/his admission to the home program to ensure that the patient is an appropriate candidate.
Hospital at Home adoptees stressed the importance of integrating the program into the culture of the organization so that it becomes part of the system’s tool kit in delivering effective care and not an after thought or add-on. Successful Hospital at Home programs will provide regular education to hospital staff, especially physicians and nurses in the emergency department, about the program (including appropriate patients and the process of admission; utilization and quality data for Hospital at Home patients).
Nurses and physicians learn important things about their patients by seeing their home environments and observing patients in their homes. For example, nurses can really observe a patient’s medication management system and help reconcile a patient’s medications. In addition, nurses can discover if a patient’s caregiver support is inadequate and determine the need for ongoing home care. In some cases, nurses find undiagnosed depression by observing a patient in her/his home.