National Nurses United pushed back against hospital-at-home programs in a Nov. 4 statement, arguing such programs do not offer patients the same level of care and threaten to cut nurses' jobs.
The union specifically named Oakland, Calif.-based Kaiser Permanente's plans to expand advanced care-at-home programs, which employ iPads and other digital technology so patients can be monitored remotely 24/7. Kaiser partnered with Rochester, Minn.-based Mayo Clinic in May to invest in Medically Home Group, a Boston-based tech services company that provides a virtual and physical delivery model for hospital-at-home programs.
"Nurses are horrified by Kaiser's attempts to redefine what constitutes a hospital and what counts as nursing care," the union statement said.
"Not only does this program endanger the imminent safety and lives of patients, it completely undermines the central role registered nurses play in hands-on care that patients need to safely heal and recover."
The union also said programs that support care outside hospital walls may cut RN staffing, place undue burden on patients' unpaid caregivers and family members, and worsen racial disparities between who is sent home for care and who receives care in the hospital.
In a Nov. 4 statement sent to Becker's, a Kaiser spokesperson resisted the nurse union's claims, saying its at-home program provides safe and quality care and does not threaten RN positions in the hospital.
"Nurses have always and will continue to play a critically important and highly valued role at Kaiser Permanente. The Advanced Care at Home Program does not limit the role of nurses in hospitals," the statement said.
"The Kaiser Permanente Advanced Care at Home is an innovative person-centered program rooted in quality, safety and patient satisfaction. Patients enrolled in the program must meet established clinical and safety criteria. Regardless of whether the patients are receiving care in the comfort of their own home or in a hospital, we hold ourselves to the same high standard of care. The program empowers multidisciplinary care teams to provide the right care at the right time, meeting our patients where they want to be," the health system's statement said.
Many large health systems heading up hospital-at-home programs say they offer patients advanced care from the comfort of their homes at a lower cost, lower hospital admission rates and have supported flexible capacity amid the COVID-19 pandemic.
Kaiser launched KP@Home — its implementation of Medically Home's care model — in its Northwest and Northern California regions in 2020. At least 500 patients had been treated from home under the model as of July, Stephen Parodi, MD, executive vice president of the Permanente Federation, told Becker's.
"We have seen improvements in patient satisfaction and reductions in healthcare-acquired conditions when compared with traditional hospitalization," Dr. Parodi said. "We are also finding a greater ability to identify social determinants that are affecting a patient's health and making community connections to address issues such as food insecurity."
Last month, Kaiser and Mayo launched a coalition along with other large systems to properly regulate hospital-at-home models, transform laws that currently link hospital medicine to a building to include a virtual model, and drive best hospital-at-home practices.
In November 2020, CMS created its Acute Hospital Care at Home program, which allows hospitals to receive Medicare reimbursement for at-home care services provided to patients for more than 60 conditions. As of Oct. 26, more than 186 healthcare organizations, including Cleveland Clinic and Boston-based Brigham and Women's Hospital, were approved to participate in this program.