The Growing Patient Preference for Care at Home

For those of us in good health, spending time at home is something we largely take for granted. It is the hub of our everyday lives, where memories are made, and time is spent with loved ones; a place for rest and relaxation. It’s no surprise, then, that many people express a desire to receive their healthcare at home, rather than away from it.  

The COVID-19 pandemic highlighted this preference, as telehealth services grew at an astonishing rate. Fears of infection exposure, challenges with overcrowded hospitals, and the Medicare Hospitals Without Walls waivers drove highly skilled medical care home as well. Unsurprisingly, even post-COVID, Contessa has seen continued interest in this type of care from both patients and providers.  

These stakeholders have not only seen the positive effects of medical care in the home during the pandemic, but they also know that the experience has become an expectation. At Contessa, we understand the desire for this type of care delivery extends well into the future for several reasons. 

Our hospital level care-at-home program, Recovery Care at Home, was so successful that in 2022 we launched our Comprehensive Care at Home model, which represents a full continuum of care in the home, including Rehabilitation Care at Home (in lieu of skilled nursing facility care) and Palliative Care at Home. Together with our parent company, Amedisys, Inc., we are heeding the growing patient preference for care at home and bringing a suite of healthcare services where patients want to receive it.  

What are the primary forces driving healthcare home? 

Patient preference is a big driver of care at home, but it’s intertwined with several other driving forces as well. These include the following: 

•  It reduces healthcare fragmentation- multiple specialists and services require careful care coordination to avoid duplication of testing and treatment. Contessa’s model of care brings these services together with extensive coordination of providers and follow-up care. An excellent example of this is Palliative Care at Home. 

•  It’s less costly- Patients may not always need the facility, just the resources the facility provides. Bringing resources to the home when patients don’t need facility-based care means they also don’t incur facility-based costs. For example, one study found that the cost for an acute care episode at home was 38% less than a hospital stay. Payers are beginning to recognize this and look for ways to implement it on a larger scale.

• The US population is aging- the population of adults aged 65 and older has grown by over 34% in the last decade, and is projected to reach 94.7 million by 2060. This aging population brings with it a subsequent increase in chronic conditions like congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), two of our commonly treated conditions. Care at home offers a resource for this increased need for care. 

• Healthcare facilities have limited capacity- we saw increased wait times and lack of available beds during the COVID-19 pandemic, but even before COVID-19 it was not uncommon for patients to face long waits, a problem now only exacerbated by staffing shortages. By bringing medical care to the home, providers find a simpler, more cost-effective solution to building additional hospital towers.

What are some reasons patients prefer to receive healthcare at home? 

The factors discussed above drive patient demand for the type of care we can deliver at home. Beyond that, the simple fact that home is familiar and comfortable is a major influence on the increased preference for healthcare at home, along with these solid reasons: 

• It’s convenient- when care is brought to the home, it eliminates the need for transportation to and from a facility for care, including follow-up visits, testing, etc. This is also true for families, who are often valuable support persons that patients need physically present for their well-being and recovery.

• The hospital experience is not always a good fit for recovery- the hospital often does not create a patient-centric experience – it is by design a hospital-centric experience. Patients’ rest and recovery are affected by practices like lab draws at 4:30 am and disrupted sleep due to the sounds and lights of nocturnal care teams. At home, patients can largely maintain their familiar routines and rest better in their own beds.

• It offers individualized care- in a facility, patients are only one patient out of a larger census for hospitalists and nurses. At home, patients become the center of the experience- they receive care that is focused on them, in their environment, where they are seen in their own world and not just as a patient in a gown. 

How will the aging population affect the preference for care at home? 

As previously mentioned, with the increasing population of aging adults in the US comes an increased demand for care for chronic health conditions. It is estimated that 85% of older adults have at least one chronic health condition, and 60% have at least two. 

Not only that, but 77% of older adults express a preference for “aging in place”- the practice of staying as independent as possible for as long as possible in their own homes. These two factors- the increased need for care and the preference for aging in place- mean that there is a need to move the care these patients normally receive in facilities to the home. This includes labs, physician visits, skilled nursing care, skilled therapy services such as physical, occupational and speech therapy, medication delivery, and more.  

Especially in underserved populations, it is not always realistic or possible to ask patients to travel to a facility to receive these services. There are many factors at play in a patient’s home environment that can create barriers to effective care. The ways in which these social determinants of health (SDOH) impact care are so important, the US Department of Health and Human Services (HHS) has created a Healthy People 2030 Goal to “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.”   

Contessa’s Comprehensive Care at Home uniquely addresses social determinants of health. By bringing care home, we make services more accessible for many of our patients and we also have a unique opportunity to see them as they are, in their own environment, along with everyday challenges they may face. In this way, we meet both the demand for care at home and the need for high quality healthcare, an outcome reflected in our patient satisfaction ratings which consistently stay above 90%.  

How the growing patient preference for care at home is driving the future of medicine 

With all the above factors affecting care at home, it is easy to see how programs like Comprehensive Care at Home are driving medicine’s future. Healthcare at home addresses several important facets of care, which in turn informs the growing demand for this approach. By bringing different segments of care together in one unified, personalized location for patients, we can honor the fact that patients’ lives and medical needs do not fit into a single box.   

Contessa’s expansion beyond the hospital at home model is an example of how we recognized that just providing a single service at home does not address all healthcare needs. As we have built a full continuum of care in the home to expand our ability to meet these needs, we have redefined how and where all care is delivered. With patients expressing their continued approval of this approach, Comprehensive Care at Home is the healthcare model of the future.