ST. LOUIS − Maria Alexander was at home recovering from surgery when she spiked a fever and ended up in the emergency room at Mercy Hospital St. Louis. It turned out she had an infection and congestive heart failure and would need IV antibiotics, which must be administered with hospital oversight.
“I love Mercy, it’s the only hospital I feel comfortable going to,” Alexander said. “Though, because I was independent, able to unplug my IV and walk to the bathroom, I didn’t really feel I needed to be in the hospital.”
Cue Dr. Aaron Pickrell, Mercy hospitalist and regional medical director of Mercy Hospital-at-Home, who approached Alexander with a new program.
“Dr. Pickrell told me about a program that just started and asked if I would like to be part of it,” Alexander said. “He said they would send me home in an ambulance and care for me like I was in the hospital. There was no hesitation, I said ‘YES!’”
Just like Alexander, Marty Kiefer’s most recent visit to Mercy Hospital St. Louis ended with a move into his home.
Wheelchair bound, Kiefer has experienced many hospital stays in his life while battling multiple sclerosis and congestive heart failure. After a recent ambulance ride to Mercy, Kiefer was diagnosed with pneumonia. While waiting for an available hospital bed to treat his all-too-common diagnosis, he was approached by Dr. Pickrell, who explained Mercy’s new Mercy Hospital-at-Home program.
“Pneumonia is a condition often treated with IV antibiotics, which requires monitoring by a hospital team but can easily be done in the home,” Dr. Pickrell said.
How it Works
In 2020, the Centers for Medicare & Medicaid Services (CMS) gave hospitals the flexibility to provide health care for patients in their homes. The move was critical during the pandemic when hospitals across the country managed an extreme increase in patients, bed shortages and staffing challenges. The CMS waiver for at-home acute care has since been extended as the U.S. Department of Health and Human Services analyzes the results of hospital at home programs.
“Mercy’s virtual care experience with COVID Care at Home helped provide valuable insight when discussions of expanding to more diagnoses arose,” said Dr. Ann Elizabeth Mohart, Mercy vice president of care transitions. “We know certain patients can be safely cared for at home and look forward to expanding the program to even more patients.”
The Mercy Hospital-at-Home program, which launched in St. Louis last September with plans to eventually expand across Mercy, is designed to cover all aspects of care that would normally be provided in a brick-and-mortar hospital. The program is run by an interdisciplinary team of acute care-level doctors, advanced practice providers, nurses, pharmacists, therapists and other health care professionals who oversee patient care through a combination of in-person and virtual visits. Once patients arrive home, a registered nurse sets them up with monitoring equipment, medication, therapy and other services, as needed.
Patients who meet certain criteria have the opportunity to opt in to receive their care at home rather than being admitted to a hospital, or, in some cases, transition home after a brief hospital stay.
“It’s no fun to be in the hospital, in a different environment without the comforts of home. In this care model, we bring the hospital to our patients,” Dr. Pickrell said. “We’re typically met with some natural hesitation when the program is first presented as an option to patients, and that’s understandable. But once we describe the process, how we supply everything they’ll need and they know they have around-the-clock access to our team, they’re ready to pack their bags and head home for care.”
Care in the Comfort of Home
Alexander decided to give the program a shot, but felt more comfortable staying with her daughter, Becky Rhoads, who could keep an eye on her and help monitor her care.
“My first thought, it sounded too good to be true and I asked, ‘What’s the catch?’” Rhoads said. “Once I was reassured that it was covered by Medicare and I saw my mom perk up when they told her she could go home, I dropped all my reservations.”
Once they all agreed, the team began gathering Alexander’s belongings and all the supplies she would need at home.
“I went home to prepare and the next thing I know they were at my door. My mom, the medical team – all the same people I was just talking to at the hospital – were all in my living room,” Rhoads said. “I was surprised how fast it all happened, it felt like VIP treatment.”
Nurses visited Alexander twice a day, an advanced practice provider or doctor once a day and she was given a device for virtual visits in between. Alexander could also call a number for needs that might arise at any time, day or night.
Kiefer described a similar experience. The 60-year-old was transported home via ambulance, and the Mercy Hospital-at-Home team was there and ready to go.
“When we got home, there were five medical professionals in our bedroom ensuring he was in the right position, that he was comfortable and all the IVs were hooked up properly,” Kiefer’s wife Beth said. “They even offered to have meals delivered, which was appreciated but not needed.”
Recovering in Peace
The road to recovery after a hospital stay can last days or weeks and for older adults, the process can take longer. According to the National Council on Aging, it takes one week to recover for each day an older adult spends in the hospital.
Both Alexander and Kiefer were happy to speed up the healing process.
“Being home really does make a difference. It was peaceful – no sounds or unwanted lights,” Kiefer said. “Recuperating is easier in your own bed. The program is a miracle. It’s given me a better outlook.”
“Everyone was so awesome,” Alexander said. “I recuperated in a more peaceful way. I didn’t have to push buttons and I got to be with my family. It made me forget I wasn’t well. I felt very blessed and privileged to be part of the new program.”