Background: The Mount Sinai at Home (MSaH) program is a continuum of care that includes Hospitalization at Home (HaH), Palliative Care at Home and Subacute Rehab at Home (RaH). With these care delivery models, we can meet a wide and expanding spectrum of patient care needs. At MSaH, hospitalists, nurses, physical and occupational therapists, social workers and care coordinators provide care via a combination of telehealth and in-person support. This workforce and infrastructure has allowed us to leverage our Mount Sinai at Home resources during periods of emergency to meet the needs of our health system.
Purpose: During rapid surges in care, there are many challenges that a home-based program is uniquely positioned to address including patient mistrust of hospitals, limited bed capacity and equitable access to care for a diverse patient population. At Mount Sinai, recent examples include the COVID-19 pandemic and a large hospital nursing strike. MSaH’s workforce, skillset, and experience in coordination of care safely transitioned appropriate patients to the home setting, increasing overall health system capacity and reserving traditional beds for those with higher acuity and reversible illnesses.
Description: In 2023, MSaH admitted a total of 492 patients to its HaH and RaH services with a total of 2,432 bed days saved (HaH only). Through October 2024, 639 patients have already been admitted with 4,110 bed days saved (HaH only). In 2023, 56% of our patients were female with an overall average age of 70. Nearly 60% of patients admitted to HaH had Medicare, 42% with Medicaid and 10.7% with commercial insurance. 39% of our patients identified as Hispanic, 25% White and 21.4% Black.
Conclusions: Home-based care programs should work closely with the health system’s Emergency management to ensure this ability is understood and measured with workflows in place that can be rapidly triggered if needed. Regulatory barriers can limit staff ability to rapidly change roles and move into the community settings.