Healthcare in the Home Models

Healthcare in the home models deliver healthcare services directly to a patient’s private residence, addressing the common rural barriers of distance and transportation. These programs can ensure prompt treatment, proactively identify health issues that require escalation, and improve continuity of care through improved communication between the patient and their primary care provider.

Hospital-at-Home programs

Hospital-at-home programs deliver acute-level care to patients in their homes. Hospital-at-home programs are intended for patients who have a serious but stable condition, with adequate space and resources at home. Providers can deliver care through in-home visits or through technology or other telehealth software, which can reduce costs and improve patient outcomes. Most programs end within 30 days, at which point the at-home provider will coordinate with the patient’s regular medical team, if able, to create a plan for when the at-home care ends.

Nurse-family partnerships

Nurse-family partnerships are a promising model for delivering healthcare in the home designed to improve health outcomes for new, low-income mothers and their children. Nurses are paired with mothers during pregnancy, and the partnership continues after childbirth, until the child turns two. Nurses teach self-care for the mothers, how to care for the child, and child growth and development.

Palliative care and hospice care

Palliative care and hospice care are related, but distinct, approaches to care. Palliative care refers to care given to individuals with critical or chronic illnesses focused on prioritizing their comfort, dignity, and quality of life. Hospice care is a specific type of palliative care given only to individuals at end of life, who have a prognosis of six months or less. For both palliative and hospice care, care is typically offered to individuals in the comfort of their own home. Some hospice programs have home-like facilities where patients can be transferred to manage symptoms in their final days of life.

For more information, please visit the Rural Hospice and Palliative Care topic guide.

Home health

Home health services provide skilled healthcare to individuals in their homes and can support a range of healthcare needs, including chronic disease management, rehabilitation, recovery from illness or injury, and assistance with maintaining independence. Services may include skilled nursing care, medication management, wound care, physical therapy, occupational therapy, speech-language pathology, patient and caregiver education, and monitoring of chronic conditions. Home health models often combine in-person visits with telehealth, remote patient monitoring, and care coordination services. In rural communities, home health providers may work closely with primary care providers, hospitals, community paramedics, and social service organizations to coordinate care and address barriers that affect health and well-being.

Post-acute care is one component of home health and refers to the medical monitoring and care a patient receives following a hospital stay or intense inpatient intervention. For some individuals, post-acute care can be provided at home. The services offered post-discharge can overlap with the services hospital-at-home programs provide, with both focused on providing treatment outside of traditional settings.

For more information about how mobile healthcare models can be used to provide care for individuals with chronic conditions or who have recently been discharged, see the Mobile Models for Chronic Disease Management section.

For more information, visit the Rural Home Health Services topic page.

Examples of Rural Healthcare in the Home Programs

Mountain Empire Older Citizens is a state-designated area agency on aging located in southwest Virginia. It provides a range of community services, including Mountain Empire PACE (Program of All-Inclusive Care for the Elderly), a nationally recognized healthcare program for seniors. The PACE program provides wraparound services to support independent living among older adults, including home visitation for nutrition, physical therapy, personal care, and skilled nursing.
The Huntsman Cancer Institute, part of the University of Utah Health system, has a hospital-at-home service specifically for cancer patients. Providers can help monitor and treat chemotherapy-related symptoms, like nausea and dehydration, for cancer patients, and even provide palliative and hospice care for enrollees.
Blessing Health System and Hospital, located in Quincy, Illinois on the border of Missouri, offers a robust home care program. Whole patient health is the central focus, offering services including wound care, medication management, patient education, and physical and occupational therapy. To work with a home healthcare specialist, individuals need a referral from their primary care provider. From there, providers work with patients to improve their health and quality of life.

Implementation Considerations

Implementation considerations for programs that provide healthcare in the home include costs, staff safety, and staff support.

Costs. The costs of healthcare in the home vary depending on the services provided. While some services may be covered by insurance, others, particularly non-medical home care, may not be. It is important for providers and families to understand coverage limitations, as out-of-pocket costs can be substantial for patients if services are not covered. At the program level, reimbursement mechanisms like the Acute Hospital Care at Home (AHCAH) initiative — organized by the Centers for Medicare and Medicaid Services (CMS) in the wake of the COVID-19 pandemic — provide payments to participating hospitals and health systems rather than individual patients. While such initiatives can help offset program expenses, the overall financial impact of delivering care in the home remains an important consideration for providers and patients.

Staff Safety. Safety is of the utmost importance for healthcare workers who may travel alone and long distances. Programs can consider policies and procedures to address safety, such as:

Prohibit staff from carrying large amounts of cash or medications in the car
Require home visitors to share travel routes with supervisors
Provide guidance on how to deal with aggressive or unfriendly pets
Make it standard practice to visit homes in pairs or meet in-person with supervisors or other home visitors
Provide safety resources, like de-escalation training to help home visitors identify and prevent interpersonal conflicts

It is important to recognize that the long distances between homes or communities in rural areas may present logistical challenges that make it difficult to implement some safety practices.

In some cases, people who could benefit from home visiting services may be unwilling to permit access to their homes. These may include families experiencing challenges such as substance use, domestic violence, or other complex problems or an older adult who lives alone. Home visitors who are unwelcome can consider identifying a neutral location to meet away from the home or working with family members to gain trust.

Staff Support. It is important to provide support to home visiting staff, who often work with families dealing with challenging issues. This can include regularly scheduled contact with a supervisor, training and support to address burnout, and opportunities for peer support, such as meeting with other home visitors to share successes, brainstorm solutions to challenges, and offer emotional support.

Program Clearinghouse Examples

Resources to Learn More

Bridging the Home-Based Primary Care Gap in Rural Areas
Document
Explores innovative ideas for the provision of home-based healthcare services in rural areas, based on existing evidence.
Author(s): Rogers, G., Smith, M., Gonzalez-Smith, J., & Saunders, R.S.
Citation: Health Affairs Forefront
Date: 2/2024

Home Visiting Evidence of Effectiveness (HomVEE)
Website
Created to identify evidence-based and effective home visiting programs for pregnant women and children up to age 5. Provides information about home visiting program activities, outcomes, and implementation. Useful for federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grantees, who must invest a certain proportion of their funding into evidence-based programming.
Organization(s): U.S. Department of Health & Human Services, Administration for Children & Families