The sound is unmistakable: beeping monitors, coughing patients, the chaos of an overcrowded emergency department. Last winter, as state reports showed wait times at “all-time highs,” Rhode Island hospitals were stretched thin. Patients spent more than three hours on average in the emergency department, among the longest waits in the country. For many, especially older adults, being admitted to the hospital felt like the only option.
But it isn’t anymore.
Today, some patients are recovering in their own homes surrounded by family, sleeping in their own beds, all while receiving hospital-level care. Hospital-at-Home programs send teams of doctors, nurses, and other care-team members to visit patients in person and monitor remotely, allowing patients to receive the same acute care they would inside a hospital.
This isn’t experimental medicine. Since Medicare authorized Hospital-at-Home in 2020, more than 400 hospitals nationwide have adopted the model, including systems serving Rhode Island communities. Kent Hospital and the Providence VA have Hospital-at-Home programs; Brown University Health was approved to launch one last year. Patients treated at home often recover better. Medicare spending in the 30 days after discharge is significantly lower for these patients, largely because they experience fewer complications and require less follow-up care.
Clinical studies show even stronger results. One randomized trial found readmission rates of just 7 percent for patients treated at home, compared to 23 percent for those treated in traditional hospitals, according to the Agency for Healthcare Research and Quality. Rates of delirium – a serious risk for older patients – were also far lower (9 percent vs. 24 percent). This shows that patients often do better at home than they would have in the hospital due to this program.
Hospitals in Rhode Island regularly operate near capacity. Hospital-at-Home gives providers a way to care for more patients without building new facilities or overextending staff. It also offers patients an opportunity to recover in familiar surroundings, near family, without the risks that come with prolonged hospital stays.
And yet, despite all of this, the future of Hospital-at-Home is uncertain. It exists only because the federal government has temporarily waived long-standing rules built around a simple assumption: that hospital care must happen inside a hospital. Medicare is permanent law. Hospital-at-Home is still treated as an exception.
Although Congress extended the program through 2030, that renewal comes without the promise of long-term stability. Hospitals are being asked to invest in staffing, technology, and new care models without knowing whether the program will still exist long-term. Such uncertainty slows adoption and limits access for patients who could benefit today.
Further, it creates risk. During government shutdown threats or lapses in federal authority, hospitals face uncertainty about whether they can continue admitting patients into these programs. Even temporary disruptions can force providers to scale back services, sending patients back into already crowded hospitals.
Hospital-at-Home works. It improves outcomes, reduces complications, and lowers total Medicare spending after discharge. The question now is whether lawmakers are willing to treat it as a permanent part of the healthcare system or continue managing it as a temporary exception.
For Rhode Islanders, the stakes are clear. Nearly one in five residents rely on Medicare, according to Healthinsurance.org. Federal policy decisions directly shape how care is delivered across the state. At a time when hospitals are under pressure and the need for innovative, efficient healthcare models is growing, policymakers should support solutions that improve health outcomes.
Therefore, Congress must act to make it permanent. This is not a partisan issue. Both parties continue to call for better outcomes and lower costs in healthcare. Hospital-at-Home delivers both. Will our lawmakers support innovation that works?
Health care innovation is hard, and it should be. But when something works – when it improves care and reduces strain on the system - – we shouldn’t leave it in limbo.
Sam Loranger is a senior at Providence College, studying Business Management and Health Policy & Management in the Honors Program. A North Providence native, he serves as an advisor in the Patient Experience department at Kent Hospital.