Edison, N.J.-based Hackensack Meridian Health resumed its Hospital From Home program on Nov. 17, following a nearly two-month pause triggered by the Oct. 1 government shutdown, which caused the CMS waiver authorizing acute hospital-level care at home to lapse.
The health system launched the program in late April 2024 after a successful 2022 pilot. Since then, it has cared for about 1,300 patients across five of its sites. When Hackensack Meridian learned the waiver would expire due to the government shutdown, it had to stop taking new admissions.
“Because the average length of stay for these patients is about four and a half days, we stopped taking new admissions roughly five days before Oct. 1,” Regina Foley, Ph.D., RN, president of specialty hospitals and clinical services and chief nurse executive at Hackensack Meridian Health, told Becker’s. “That way, patients could finish their care at home before the shutdown took effect, and we wouldn’t be forced to abruptly transfer acute patients back into the hospital.”
As existing patients completed their care in the final days of September, the caseload naturally wound down. By Oct. 1, only one patient remained, and they were appropriate for home IV therapy, making the shutdown seamless for them, according to Dr. Foley. However, because the health system was no longer admitting patients to the program, its hospitals had to absorb those cases into their inpatient beds.
Fortunately, the pause was temporary. Hackensack Meridian reactivated the program on Nov. 17, a process that required extensive internal communication with providers and physicians, especially the health system’s ER physicians and chiefs of medicine.
“Part of that communication was reminding providers that, when appropriate, their patients could receive hospital-level care at home rather than in a bed on one of our inpatient units,” Dr. Foley said.
Reopening the program also required reorganizing the workforce. Hackensack’s hospital-based nurses, advanced practice nurses and providers are the ones who deliver care in the home, so their schedules and assignments had to change.
“These are incredibly skilled clinicians: nurses, techs, respiratory therapists, pharmacy techs, physicians, advanced practice nurses. They are the people you would want caring for your own family. And they want to do this work,” Dr. Foley said. “When the program paused in October, they were redeployed across the system. They did the work, but they weren’t happy, because their passion is delivering acute care in the home.”
As of Nov. 21, the Hospital From Home program was caring for 20 patients, and Ms. Foley said she expects the caseload to reach 30 to 35 during the week of Nov. 24. Still, the health system is preparing for another potential pause. The federal spending package signed Nov. 12 extends the CMS waiver only through Jan. 30, making another shutdown a possibility.
“As we get closer to the end of January, if we don’t see movement on funding, we’ll have to prepare again,” Dr. Foley said. “That means stopping admissions around Jan. 25 and transitioning patients back to the hospital. It also means redeploying our workforce — which is another major stress point.”
When asked what she wishes federal policymakers better understood about the fragility of innovative care models like this one, Dr. Foley urged them to see the program through the eyes of families.
“Being sick is already difficult, but if that illness could be safely managed at home, I think any elected official or government leader would want that option,” she said. “If you needed hospital-level care, why not challenge the assumption that it must be delivered inside a hospital? Why couldn’t it be delivered in your home? We cared for 1,300 patients safely and successfully at home, with no readmissions back to the hospital. Their satisfaction was high, and their health improved.”
Dr. Foley added that Hackensack Meridian Health believes the program could offer long-term benefits for the country — and ending it prematurely would be “short-sighted.”
