With an unprecedented demographic shift, notably in the USA—with over 10,000 people turning 65 each day—healthcare systems must adapt rapidly to address the mounting pressures of an ageing population and strained hospital capacities. Occupancy rates have climbed to 75%, a significant rise since the pandemic, highlighting the urgent need for alternative models of care. At the forefront of this transformation is the concept of hospital-level care delivered directly in the home. Mass General Brigham’s Home Hospital initiative demonstrates how this approach not only addresses growing demands but also enhances patient outcomes and provider satisfaction.
Delivering Acute Care Where Patients Live
The Home Hospital model represents a shift toward patient-centred, technology-enabled care that extends beyond the confines of traditional hospital walls. At Mass General Brigham (MGB), this model has evolved into one of the largest services of its kind in the United States, expanding to 70 virtual beds by 2024. The programme, operational across five hospitals and 71 communities in Massachusetts, enables patients to receive acute care for conditions such as COPD, atrial fibrillation, heart failure and postoperative recovery from procedures including spinal and bariatric surgery—all from the comfort of their homes.
Must Read: Care Closer to Home: A New Healthcare Model
Evidence supports the efficacy of this model, particularly for older patients, where hospital settings may exacerbate conditions like dementia-induced delirium. Home care not only mitigates risks of hospital-acquired infections but also provides an environment where clinicians can better assess social and environmental determinants of health. Importantly, caregiver burden has not been shown to increase in this setting, according to multiple studies. In fact, patient satisfaction is high, and clinical outcomes, including complication and mortality rates, are favourable when compared to traditional inpatient care.
Expanding Reach and Navigating Operational Challenges
While promising, scaling the Home Hospital model to serve broader populations presents challenges. Currently, most patients receiving home hospital care reside in urban areas. MGB is actively pursuing outreach into rural regions, including an initiative supported by the Advanced Research Projects Agency for Health aimed at delivering home-based services across the Carolinas. Expanding to these areas will require overcoming barriers such as physical distance, logistics and internet connectivity.
Staffing is another pressing concern. With a projected shortfall of 100,000 healthcare workers by 2028, building a workforce skilled in delivering home-based acute care is crucial. MGB’s experience indicates that these roles can improve job satisfaction and reduce burnout, provided clinicians are supported by strong interdisciplinary teams. Technological innovations—such as remote monitoring devices, tablet-based communication and physical visits by paramedics and nurses—form the backbone of service delivery. To further enhance efficiency, MGB is testing drone delivery systems to manage the transport of medical supplies and equipment, particularly in congested urban areas.
Building Infrastructure for Sustainable Growth
Sustaining and expanding Home Hospital programmes will require consistent funding, regulatory support and infrastructure investment. Although over 390 hospitals in 39 states are authorised to deliver acute care at home, only a fraction currently do so. Differences in implementation and lack of standardisation hinder comparisons and raise concerns over quality consistency. However, a 2024 review by the Centers for Medicare & Medicaid Services concluded that outcomes for patients in home hospital programmes match or exceed those of inpatient care.
Technology will continue to play a pivotal role in the evolution of these services. MGB’s partnership with Best Buy Health has led to the development of customised systems for remote monitoring, virtual consultations and integrated care coordination. These tools enhance both patient experience and provider capabilities. Furthermore, education remains critical to patient acceptance. While many patients embrace the idea of recovering at home, some remain hesitant. Targeted outreach and reassurance will be necessary to ensure broader adoption of this care model.
The future of acute care may well lie in the homes of patients. Mass General Brigham’s Home Hospital programme illustrates how this innovative model can meet the dual challenges of increasing demand and limited hospital capacity, while maintaining high standards of care and patient satisfaction. For such models to flourish, a concerted effort is needed to invest in infrastructure, train dedicated professionals and address regulatory and logistical barriers. Home-based acute care represents a transformative step towards more sustainable, equitable and effective service delivery.
Source: Journal of Healthcare Management
Image Credit: iStock
