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The home field advantage: Reducing hospital admissions and length of stay with in-home care

As a practicing hospital-based physician, it probably goes without saying that I strongly believe in the power and quality of care administered in the hospital setting. However, more than 10% of all hospital days are unnecessary and driven by non-medical reasons1,2; and multi-visit patients account for more than a quarter of all emergency room (ER) visits, many of which end in unnecessary hospitalizations driven by social risk factors – such as social isolation and a lack of reliable transportation.3 This is an unacceptable reality of our country’s healthcare system that leads to serious consequences as patients in these circumstances feel afraid and powerless4; and hospitals get overcrowded, leading to boarding in the ER, longer lengths of stay, and worse outcomes5,6, not to mention the incredibly high cost associated with hospital stays.

To help our health system customers bend the curve on length of stay and non-medically necessary hospitalizations – historically known as social admissions – and address these social risk issues head-on, Sharecare implemented a program through our tech-enabled home care service, CareLinx, to facilitate hospital discharge for medically stable patients with social or functional limitations, whether they are in the ER or have been admitted to the hospital. The program quickly places highly-vetted non-medical caregivers in patients’ homes, assisting them with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and can even support care management efforts with in-home biopsychosocial assessments. As we have worked to increase the impact of our program and expand its scope beyond facilitating the discharge of hospitalized patients, we’re enthusiastic about its potential to support even more use cases and help avoid non-medically necessary admissions from the ER, which typically occur when a patient presents with social issues or lack of appropriate support at home, and they have nowhere else to safely go without help. 

Although it can be difficult to quantify the life-changing impact of qualified caregivers in the home on patients and their families, a recent case at one of the largest non-profit health systems in the Northwest highlights the tangible value of Sharecare’s program. At the beginning of April, this customer referred a 60-year-old bedridden hospital patient to our program, as she lives alone without consistent social support while battling asthma, diabetes, cardiac disease, and bowel and bladder incontinence. A CareLinx caregiver was deployed to her home the following day, quickly and safely facilitating hospital discharge. Several days later, the patient was feeling worse and visited the ER, where she was diagnosed with a UTI but could not be discharged home because of her historical lack of in-home support. However, by working closely with the hospital case managers, we were able to deploy another CareLinx caregiver to her home that day, avoiding unnecessary readmission.

Without CareLinx, this patient would have remained hospitalized during her initial stay for an additional 10 to 14 days, which would have cost the hospital upwards of $30,000.7 Due to her lack of in-home support, she also would have been readmitted when she presented to the ER, costing her insurance on average $15,200.8 For this single patient, CareLinx by Sharecare directly reduced her potential total cost of care by $45,000.

After working with our professional non-medical caregivers and seeing how they can help improve health outcomes and cost savings, I believe that home care plays a critical role in avoiding unnecessary acute care utilization and reducing total hospital days and readmissions. More importantly, the impact of caregivers goes far beyond reducing the cost of care; it also gives patients the immeasurable gift of being able to age in place with dignity and to live happier, healthier lives, for longer.

References

  1. Kim CS, Hart AL, Paretti RF, et al. Excess hospitalization days in an academic medical center: perceptions of hospitalists and discharge planners. Am J Manag Care. 2011;17(2):e34-e42. Published 2011 Feb 1.
  2. Carey MR, Sheth H, Braithwaite RS. A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service. J Gen Intern Med. 2005;20(2):108-115. doi:10.1111/j.1525-1497.2005.40269.x
  3. Jiang HJ (AHRQ), Weiss AJ (IBM Watson Health), Barrett ML (M.L. Barrett, Inc.). Characteristics of Emergency Department Visits for Super-Utilizers by Payer, 2014. HCUP Statistical Brief #221. February 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www​.hcup-us.ahrq​.gov/reports/statbriefs​/sb221-Super-Utilizer-ED-Visits-Payer-2014.pdf.
  4. Huang M, van der Borght C, Leithaus M, Flamaing J, Goderis G. Patients’ perceptions of frequent hospital admissions: a qualitative interview study with older people above 65 years of age. BMC Geriatr. 2020;20(1):332. Published 2020 Sep 7. doi:10.1186/s12877-020-01748-9
  5. White BA, Biddinger PD, Chang Y, Grabowski B, Carignan S, Brown DF. Boarding inpatients in the emergency department increases discharged patient length of stay. J Emerg Med. 2013;44(1):230-235. doi:10.1016/j.jemermed.2012.05.007
  6. Bernstein SL, Aronsky D, Duseja R, et al. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med. 2009;16(1):1-10. doi:10.1111/j.1553-2712.2008.00295.x
  7. Hospital Adjusted Expenses per Inpatient Day. KFF. Updated 2022. Accessed April 11, 2024. https://www.kff.org/health-costs/state-indicator/expenses-per-inpatient-day/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
  8. Jiang HJ, Hensche MK. Characteristics of 30-Day All-Cause Hospital Readmissions, 2016-2020. HCUP Statistical Brief #304. Rockville, MD: Agency for Healthcare Research and Quality; September 2023 www.hcup-us.ahrq.gov/reports/statbriefs/sb304-readmissions-2016-2020.pdf.
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Categories: Caregivers, CareLinx