Professional Insights

Hospital-at-Home Care: Opportunities & Considerations for Non-Medical Providers

04/18/2025

Healthcare delivery in the U.S. is undergoing a significant transformation, with Hospital-at-Home (HaH) programs emerging as a viable alternative to traditional inpatient care. This model enables certain patients to receive hospital-level treatment in their homes, leveraging remote monitoring, telemedicine, and in-person nursing visits to deliver care safely and effectively.

For non-medical home care providers, this shift presents a unique opportunity to expand their role in healthcare, supporting HaH programs by offering critical services that complement medical care. Integrating non-medical support into a hospital-level home care model requires understanding the benefits, challenges, and key considerations for home care agencies, hospitals, and patients.

What is Hospital-at-Home?

The Acute Hospital Care at Home waiver, which hospitals can apply for and, if granted, can participate in, was first developed in 1995 by The Johns Hopkins School of Medicine and Public Health. It provides hospital-equivalent care in a patient's home for conditions that traditionally require inpatient admission, including Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), Urinary Tract Infections (UTIs) requiring IV antibiotics, and Pneumonia.

The model is designed for medium-acuity patients—those who require hospital-level care but are stable enough to be monitored at home using a combination of telehealth, remote monitoring, and in-person clinical support.

The Current State of Hospital-at-Home

The expansion of HaH programs has accelerated, as a result of the COVID-19 pandemic, as hospitals sought alternative care delivery models to alleviate inpatient capacity constraints. As of December 2024, more than 378 hospitals in 39 states have received the Acute Hospital Care at Home Waiver (AHCAH) providing care to more than 32,000 patients.

Reimbursement and Regulatory Framework

Despite its growing adoption, the Hospital-at-Home model faces reimbursement challenges. Medicare reimburses for HaH, but only eight state Medicaid programs currently cover it. Private insurance and Medicare Advantage plans will need to expand participation to make the model financially sustainable. The Centers for Medicare & Medicaid Services (CMS) has not yet developed formal Conditions of Participation (CoP) for the program, though there are existing care protocols hospitals must follow.

Care Protocols and Requirements

For a hospital to operate a Hospital-at-Home program, it must meet stringent Centers for Medicare and Medicaid Services (CMS)-established protocols, including
In-person evaluation (a physician must assess medical and non-medical factors before admission).

• Daily nursing evaluation: A registered nurse (RN) must conduct at least one daily assessment, either remotely or in-person.
• Emergency department or inpatient origin: Patients can only be admitted from an ER or an inpatient hospital bed.
• Two in-person visits per day: RNs or mobile paramedics must conduct at least two in-person visits daily based on the patient’s care plan.
• Collaboration with home health agencies: Some therapies and services may be provided by home health agencies under the direction of an HaH physician.
• Data reporting: Hospitals must report quality and safety metrics to CMS.

Why Hospital-at-Home Matters for Non-Medical Home Care Providers

An Expanding Role in Healthcare

Traditionally, non-medical home care agencies have provided services such as personal care, companionship, meal preparation, and transportation. However, as Hospital-at-Home programs grow, these agencies have a chance to become integrated partners in a hospital-based home care network.
By aligning with discharge planners, transitional care coordinators, and Hospital-at-Home program managers, non-medical home care providers can fill essential gaps in patient care that medical professionals may not cover, such as:

• Assisting with activities of daily living (ADLs) (e.g., bathing, dressing, grooming)
• Providing mobility support and fall prevention
• Ensuring home safety and medication adherence
• Offering companionship and emotional support to reduce hospital readmission risks

Benefits for Non-Medical Home Care Agencies

Business Growth and New Revenue Streams: Partnering with hospitals can lead to steady referrals from healthcare systems. Hospital at Home may create new billing opportunities through private pay, Medicaid waivers, and managed care partnerships.
Competitive Differentiation: Agencies that participate in HaH programs position themselves as higher-value providers with expertise in post-acute care. Hospitals and healthcare systems will favor agencies with proven experience in working alongside medical teams.
Enhanced Training and Workforce Development: Working within an HaH model can increase caregiver skills, requiring training in remote monitoring, care coordination, and emergency response. Agencies may also benefit from cross-training with hospital staff to improve service delivery.

Key Considerations for Non-Medical Home Care Agencies

• Understanding Hospital-at-Home Requirements: Non-medical agencies must align their services with HaH protocols, ensuring staff is trained to respond to urgent needs and coordinate care with hospital teams.
• Caregiver Readiness & Response Time: HaH programs often require rapid caregiver deployment within one hour of a hospital request. Agencies should consider maintaining an on-call team and full-time staff dedicated to HaH cases.
• Integration with Telehealth & Monitoring Systems: Caregivers must be comfortable using remote monitoring platforms and mobile communication tools to interact with hospital "Mission Control" centers.
• Managing Costs and Reimbursement: Many HaH partnerships will not be immediately profitable — agencies must be prepared to treat HaH participation as a long-term investment. Understanding the financial impact, including payer sources and operational costs, is critical.

Advantages for Patients

Patients receiving Hospital-at-Home care experience better health outcomes and higher satisfaction rates. Key benefits include:
Lower mortality and complication rates compared to inpatient hospitalization.

• A Reduced rehospitalization risk—the 30-day readmission rate for HaH patients is 7.2%, significantly lower than the national average of 17%
• More personalized care in a familiar home environment.
• Lower infection risk compared to traditional hospital stays.
• Improved patient satisfaction—most patients report higher levels of comfort and engagement in their recovery process.

The Future of Hospital-at-Home Programs

On February 2025, nearly 100 healthcare stakeholders have signed a letter urging Congress to approve a five-year extension for the Acute Hospital Care at Home (AHCaH) waiver.. Congress approved the extension through September 2025.
Hospitals and home care agencies alike will need to continue refining their workflows, staffing models, and telehealth capabilities to sustain the long-term viability of Hospital-at-Home care.

A Transformative Opportunity

For non-medical home care providers, Hospital-at-Home presents a game-changing opportunity to deepen partnerships with hospitals, expand their service offerings, and play a pivotal role in the future of healthcare delivery. By investing in caregiver training, technology integration, and hospital partnerships, home care agencies can position themselves as indispensable partners in the evolving healthcare ecosystem, ultimately improving patient outcomes while expanding their market presence.

Guy Tommasi is President and CEO of Corcoran Consulting Group. With more than four decades of on-the-ground expertise in private duty non-medical home care, his future-focused approach helps home care agencies become data-centered, value-based, service-first providers of choice for payers, clients, and their families.