Kent Hospital is like home to 90-year old Doris Witt. It is where four of her six children were born and where she went for the treatment of recent illnesses. And Kent is where she can expect to find her granddaughter, Julianna Witt an emergency department nurse.

Last week Doris’ apartment at Sparrows Point became the hospital as Kent marked the 1,000th patient admitted to its Hospital at Home program, the only one of its kind in the state.

“It’s the best thing when you don’t have to stay in the hospital,” Doris said. She is comfortable in her own space, her own bed and knowing her condition is being constantly monitored. She receives twice daily nursing visits and looks forward to seeing Dr. Tyler Weisberger once a day.

Earlier last week, Doris was having difficulty breathing. She was admitted to Kent where she was diagnosed with low oxygen levels and a mild exacerbation of congestive heart failure. Once patients with congestive heart failure are stabilized they usually stay in the hospital for several days, but in Doris’ case, and is becoming more popular with patients and physicians, she was admitted to the Hospital at Home program where she could receive treatments such as intravenous diuretics and oxygen therapy. 

In addition to continuous cardiac monitoring 24/7 patients have access to other essential inpatient services such as lab work, physical therapy, physician consults, and x-rays.

Making house calls

The program has also opened doors for those who would otherwise be making hospital room visits.

Weisberger, who has worked the program for two years, said he never dreamed his job would be so enjoyable.

“You meet so many wonderful people and it’s cool to see how they’re doing,” he said. Benefits to patients are that they feel more comfortable coming back to the hospital. And, he notes, it keeps them at home at a time like this when respiratory illnesses are rampant.

“It really sets them up for success,” he said. 

Weisberger, who trained at Kent came to Rhode Island from Maine with the thought he wouldn’t be staying. Now he thinks of Kent as his hub.

He feels “completely at ease” and enjoys the social aspect of being a visiting doctor.

Mentioning hospital beds, he said, “We can get anything needed within hours. It’s pretty amazing what we can do with the hospital team.” The team reaches beyond a patient’s discharge, which on average is between three and four days. Visiting nurses do follow ups as do physical therapists.

Yet, Weisberger acknowledges the program is not for everyone. Admission is granted only after careful evaluation of the patient’s condition as well as an appraisal of their conditions at home including support from family and friends. Pets also fit in the picture, although Doris doesn’t have one.

Kent Medical Director of the program Dr. Michael Lee said the hospital has seen the program grow steadily since it was started during the pandemic. The “game changer,” he said is when the Centers for Medicare & Medicaid Services (CMS) provided waivers enabling Medicare to pay the same as in hospital care.

Personalized medicine

“From the patient perspective it is very personalized medicine, a very different experience than the hospital,” Lee said.  He sees the program as an extension of the hospital to the home, “but it’s still a Kent patient.”

Lee, who started at Kent in the Emergency Department, said one physician and one physician assistant are on each week to manage up to 10 patients at a time and screen prospective new patients in the emergency department or the hospital floors to see if they are good fits. Expansion of the program is under consideration.

Asked whether we’re seeing a return to the days when doctors made home visits, Lee sees Hospital to Home a combo of “old medicine combined with modern spin” that provides a high standard of care often resulting in faster recoveries because patients are in an environment they know. “Nothing beats your home,” he said.

Kent’s program is part of a growing national trend in delivering hospital care in the home. According to the American Hospital Association, there are 378 hospitals across 140 health systems in 39 states that have been approved to provide hospital-at-home services to patients.

According to the association, “Studies have shown that Hospital at Home programs improve patient outcomes, reduce complications, lower hospital readmission rates, and enhance patient satisfaction—all while easing the strain on hospital capacity.”

Yet the program is still in its formative stage.

Lee points out the CMS “waiver” that laid the foundation for the creation of Hospital at Home programs (with regards to Medicare patients) is set to expire March 31, 2025.

“A five-year extension was part of a bipartisan bill that was widely expected to pass back in December 2024, but it got caught up in the end-of-year wrangling over the budget and government shut down and so the waiver was only extended until March 31, 2025.  We are expecting that the waiver will be extended further, but unclear if it will be five years or something less than that,” Lee said.

Doris, who refers to herself as “one of the birds at Sparrows [Point apartments] was discharged from the program last Friday. Throughout her stay-at-home hospital visit and for the immediate future she depends on the Blue Cross Blue Shield meal program offered recovering patients. And she will get twice weekly visits by occupational and physical therapists.

“Things are looking better,” she said Sunday.

What she likes best about the hospital program is the freedom and comfort it’s given her.

“I’m very grateful to have helpful people around me,” she said.