How Health Systems Are Turning Living Rooms Into Hospital Rooms

Erica Olenski’s North Texas home is a constant churn of activity, as is typical for a family with two young boys. Scattered about are baseball bats, book bags, bicycles. But that’s where the ordinary ends.

Olenski’s son, August, was diagnosed with an aggressive form of brain cancer in May of 2019, at 5 months old. For the next six years, their home served as a personal intensive care unit.

Semi-personal, that is. A rotating cast of health care professionals provided 24-hour care for August who, at points during his treatment, required a tracheostomy tube to breathe and a gastrostomy tube to eat. Nurses arrived at 7 a.m. and 7 p.m. each day. Physical, occupational and speech therapists augmented the team.

There was no name for this care strategy when it was presented to Olenski six years ago. But after the COVID-19 pandemic pushed more health services into nontraditional settings, it has been widely adopted and referred to as “hospital at home.” People with critical illnesses—old and young—have been receiving care in their living rooms that was once unfathomable outside of a medical clinic.

Considering what would be best for August, his family and physicians reached an increasingly popular conclusion: Hospitals aren’t always the best place for healing.

While they offer 24/7 access to medical care and quick response times in an emergency, the unfamiliar setting can have adverse effects on patients’ health. Studies have associated the noises, lights and disruptions of a hospital room with poor sleep and insomnia which can persist even after discharge. And about one in five people have “white coat hypertension,” a condition where blood pressure is normal at home, but spikes in medical settings due to stress, according to research from Harvard Medical School.

There has been a growing recognition among patients, physicians and health systems that technology can be used to address some of these issues. Since the COVID-19 pandemic planted us in our living rooms, telehealth doctors’ visits and remote monitoring tools have been used to deliver care virtually—reserving hospital beds for the most critical patients and eliminating the hassle of an in-person visit.

Oftentimes, when it comes to healing, there is no place like home. But although hospital at home programs have proved effective over the past five years—reducing stress for patients, relieving pressure on busy health care systems and posting quality care outcomes—their future fate lies in legislators’ hands.

How Do Hospital at Home Programs Work?

Demand for hospital beds skyrocketed during the pandemic. To alleviate some of the pressure on inpatient wards and emergency departments, the U.S. Centers for Medicare and Medicaid Services launched the Acute Hospital Care at Home initiative in November 2020. The new rule permitted certain Medicare-certified hospitals to provide inpatient-level care in patients’ homes. While this wasn’t the first test run for hospital at home—the model is popular around the world and had been piloted in the U.S. for specific disease cases—the legislation sparked unprecedented interest. People over the age of 65 represent a large portion of hospitalized patients, so it was tough for health systems to justify this kind of treatment without a reimbursement route for Medicare, the federal health insurance program for seniors.

By July 2025, 400 hospitals across 39 states were participating in the AHCAH program. Many of them use a combination of remote patient monitoring technology, in-home nursing and rehabilitation visits and virtual doctors’ appointments to provide hospital-level care in the comfort of patients’ own homes. Often, the remote monitoring devices can be operated with the click of a button and automatically send readings to hospitals’ data dashboards—reducing pressure on the less technologically savvy. Patients with respiratory, circulatory, renal and infectious diseases are common candidates for this type of care.

University Health in San Antonio, Texas, is one of the hospitals that launched a home care initiative. Since 2021, their award-winning Hospital at Home program has cared for more than 3,400 patients—freeing up more than 17,500 beds for sicker patients and saving the hospital more than $17 million. Patients are also likely to see lower costs when receiving care in the home. In fact, room charges can account for between 52.5 percent and 70.3 percent of hospital bills, according to a 2020 analysis of more than 195,000 pediatric hospitalizations. That’s a significant chunk of change that patients can save on boarding costs alone.

Patients utilizing University Health’s program have required fewer readmissions to the hospital and have reported improvements in care quality and overall patient experience, President and CEO Ed Banos told Newsweek. “Our hospital is in the top 75th percentile for patient satisfaction, and we see the correlation with hospital at home,” he said. “I think patients and families are excited that they’re able to get out of the hospital. It does allow the nurse to spend a little extra time [with patients and care-givers] when they’re at the home.”

OSF HealthCare, based in Peoria, Illinois, found that staff members enjoyed those visits, too.

“When we launched, it was almost too wholesome to believe it was real,” Dr. Paul Moots, chief medical officer for digital health at OSF HealthCare, told Newsweek. “People were making [staff members] food, like they were cooking them cinnamon rolls and being like, ‘Here, will you sit down and have breakfast with us?'”

Rates of staff burnout and violence toward health care workers have been rising since the pandemic, so this experience was a major departure from nurses’ norm, Moots said. “That [welcoming atmosphere] is something that I don’t think nurses have experienced to that level in a long time.”

The success is not just anecdotal. Medicare beneficiaries who received care under the AHCAH initiative had lower mortality rates, according to a September 2024 CMS report. And a June 2024 research analysis published in the journal BMC Medicine found a 25 percent reduction in mortality rates for patients who had been discharged early from an inpatient hospital stay into a hospital at home program.

In the 30 days after a patient was discharged from the hospital, Medicare spending was significantly lower in the hospital at home group than in the traditional hospital group as well.

Reducing spending is a key priority for hospital CEOs, according to Jeff DiLullo, who works with a lot of them. DiLullo leads Philips North America, which develops and provides health tech solutions across the care continuum, from MRIs and X-ray machines for hospitals, to AI analytics software, to telehealth-enabled critical care ICUs in the home.

Hospital CEOs are worried about a “triple threat” to their budgets, DiLullo said: People need more health care services than ever, and need them for longer as life expectancies go up, yet the industry doesn’t have enough staff to meet demand. As health care costs rise at a quicker pace than inflation, industry leaders are feeling the pressure to make care more affordable without sacrificing quality. He believes that virtual and hospital at home programs could be a solution.

“That’s a horrible situation,” DiLullo told Newsweek, referencing rising health care costs, “but I see these health systems moving to AI-enabled capabilities…more digital or virtual in nature, to be able to extend care over that access chasm. I can do incredible things, like very tangible things, in how I monitor, diagnose and treat a patient virtually.”

Who Are the Best Candidates for Hospital at Home Programs?

Despite the benefits, health systems recognize that hospital at home is not a fit for every patient—even if their clinical presentation fits the criteria. Program leaders told Newsweek that they conduct social screenings before referring a patient to hospital at home. Patients are typically asked if they have access to running water and electricity, family support and a roof over their head.

But some of the questions probe deeper, Moots said. OSF HealthCare asks if staff can navigate the patient’s home freely—a polite way to ask about hoarding and ensure that medical equipment can be brought into the home.

They also ask about guns, smoking, alcohol and drug use in the residence. These are strictly prohibited in the traditional hospital setting but can be tricky to regulate in patients’ personal spaces. OSF HealthCare asks patients and their family members to lock guns in a separate location, to refrain from drug and alcohol use and not to smoke around their staff members (or at all, if they’re on oxygen).

“We have to have agreements that say, ‘Hey, you can’t be using these,'” Moots said. “If we see these out, we are going to have to have a serious conversation and make sure that you’re being treated as a hospital patient and not as somebody that’s discharged from the hospital in their home.”

When care is provided in a patient’s living space, nurses also gain insight into areas where they might need more support. If they appear to be struggling with food insecurity, the health system can bring meals and connect them with services that can assist going forward, Banos said. If they’re struggling to get out of their chair at home, it’s a signal that they might need more help to function in their day-to-day lives.

“It’s kind of like training wheels so you can see if somebody’s going to be able to handle the care in their home on discharge,” Moots said.

What are the Challenges Facing Hospital at Home Programs?

OSF Healthcare has generally seen “incredibly high” satisfaction scores for hospital at home, according to Moots. But the model is far from perfect. Caregivers lose the solace and privacy that once marked their space. Oftentimes, they’re also tasked with providing medical care, making sure equipment is up to date, medications are filled and nurses show up to their shifts.

For August’s nurses, a pediatric home health agency in North Texas handled the paperwork, but Olenski was responsible for onboarding them (and offboarding when someone wasn’t a good fit).

“Your normal winds up becoming a rhythm that’s integrated with all those people that come in and out of that space,” Olenski told Newsweek.

Remote care solutions are also still working to get health care providers on board, said Oren Nissim, cofounder and CEO of Brook Health. His company partners with primary care physicians to remotely monitor patients’ health with AI-assisted technology.

Although Brook’s platform is attracting a lot of new doctors, it can take time to make them feel comfortable with this new method of care delivery, according to Nissim.

“I don’t think it’s a big technology issue anymore,” he said. “Technology is there, and frankly, for the most part, it’s actually relatively inexpensive. I think it’s way more around behavior and just how to get this to be easier ingrained within the provider habits, day in and day out.”

“On the flip side, we do see a lot more push from the local [health care] administrations to move over into a more remote care style,” he added, “so I think this is just going to continue to increase extensively.”

But that momentum is tempered by the uncertain policy environment. When CMS launched the AHCAH initiative in 2020, they did not promise that it would be permanent. The program has been extended by Congress three times, most recently in 2025 for six months. The current waivers are set to expire on September 30, 2025—which would end hospitals’ ability to provide care in the home.

Health systems and House representatives—from both parties—have been working to keep hospital at home programs alive. The Hospital Inpatient Services Modernization Act, which would extend the AHCAH program through 2030, was introduced in the House in July. Backed by professional organizations like the American Hospital Association and the Association of American Medical Colleges, the legislation also calls for a formal evaluation to compare home-based to traditional hospital care, and help CMS set standards.

On September 3, a group of 140 health care stakeholders—including health systems, digital care companies and advocacy organizations—wrote a letter to Congress, urging them to include the waiver extension in the September government funding package. If the legislation passes, it would benefit systems like OSF HealthCare that have spent much of the past five years in a waiting game.

“Our CMS waiver has been unevenly renewed, and that’s been a real struggle,” Moots said. “If you’re living six months to six months in a program that requires a lot of capital investment, that’s really tough to do.”

A longer extension would also incentivize more hospitals to invest. Many have been holding off because they’re unsure of the AHCAH’s future, according to the American Hospital Association.

“We always have to make sure that Medicare extends the [AHCAH waiver],” Banos said when asked about the greatest challenges facing hospital at home programs. “We want to focus permanently on Medicare.”

How are Hospitals Using Remote Monitoring to Reduce Admissions?

However, even hospitals that haven’t pulled the trigger on a traditional hospital at home program are finding ways to shift care into the home. Sutter Health is one of them.

The Northern California health system has launched multiple initiatives to care for patients remotely or in their homes, including Sutter Sync. The digital care program, started in March, helps patients manage chronic conditions from home using remote monitoring technology.

Currently, Sutter Sync is caring for patients with hypertension. Enrollees receive blood pressure monitors that automatically send readings to the patient’s electronic health record, enabling providers to intervene quickly when something is off. Patients also receive automated alerts when readings fall outside of normal ranges and can get personalized guidance or medication adjustments without needing to visit their doctor.

In October, Sutter Sync is expanding to help pregnant patients and those with diabetes or lipid imbalances track their health at home.

Initiatives like these allow health systems to keep closer tabs on patients throughout their care journeys, rather than only intervening in episodic visits a few times a year, according to Chris Waugh, chief innovation officer at Sutter Health.

“Our bodies are amazing,” Waugh told Newsweek. “They’re constantly at work, they’re constantly changing, and so we have to be in better coordination with the body.”

Sutter also has a home health program which sends nurses, physical therapists, speech therapists, occupational therapists, medical social workers and other care professionals into the homes of patients who have chronic conditions, are recovering from injury or illness or recently returned from a hospital stay. The program completed nearly 764,000 visits for more than 42,500 patients in 2024.

And a recent advanced home health pilot at the health system has allowed early discharge for patients who were hospitalized at Sutter’s Memorial Medical Center in Modesto, California, with congestive heart failure or cellulitis by providing them with remote monitoring devices. That program reduced 30-day hospital readmission rates for heart failure patients by 40 percent and boasts a 95 percent satisfaction rate.

Brook Health has seen similar success. In early 2023, the company began partnering with UMass Memorial Health’s Harrington Hospital in Southbridge, Massachusetts, to support congestive heart failure patients after a hospitalization. Patients were given an internet-based scale and blood pressure cuff to track their weight and blood pressure from home, while nurses followed their progress and reached out to troubleshoot in real time. After just three months of the partnership, Harrington Hospital saw a 50 percent reduction in hospital readmission rates in the 30 days after patients were initially discharged—a time span where patients are especially vulnerable to relapse.

Patients are assigned a care provider through Brook Health that works alongside an AI care bot to monitor data from the remote devices, including patient monitoring systems which track metrics like blood pressure, glucose, oxygen saturation, weight and sleep. Brook Health can respond to the data in real time—nudging patients to remind them when to take their vitals and providing health recommendations when needed.

Nissim, cofounder and CEO of Brook Health, doesn’t just attribute these wins to technology. He believes that the asynchronous access to nurses and the consistent monitoring of their health provides patients with a sense of psychological safety. Rather than asking Google for advice or rushing to the emergency department at the first feeling of trouble, patients have someone they can talk to 24/7, and the reassurance that a professional is keeping tabs on them at all times.

“When that emotional gap is filled, people just start to feel more comfortable, because they just feel safer,” Nissim said.

The Imperatives of Caring for the Caregivers

While patients may feel more comfortable in their homes, the health care system still hasn’t found a way to optimize the experience for their loved ones. More than 80 percent of caregivers who provide complex care at home say that their family member’s pain is stressful for them, according to a 2023 report from the Family Caregiver Alliance. Nearly half of them reported feeling down, depressed or hopeless and experiencing sleep disturbances.

Like Olenski, many family caregivers—more than 44 percent—coordinate care amongst various health care providers and in-home services. They report that their stress is compounded by the number of professionals they need to speak with and provide updates to.

Home life doesn’t end when the home becomes a hospital. Olenski still had to work, cook and find time to take a shower. But her space and schedule were always full.

As hospital at home programs continue to grow, she hopes that health systems will find ways to improve the experience for caregivers. True success will minimize disruption to the ebbs and flows of family routine.

“We think about the patient as central to so many things, and [the patient] is really important,” Olenski said. “But it is impossible to exclude an individual from the network in which they live and breathe and operate socially.”

Hospital at home provided unique benefits that a traditional hospital setting never could have, though. August was able to start kindergarten. He was surrounded by his family. And because August’s trach tube went directly into his lungs, he was particularly vulnerable to illnesses that run rampant in pediatric wards. Every year he was able to stay out of the hospital improved his chances.

August died from progression of his disease on June 26, 2025. He passed away at home: “a major win” considering the severity of his condition at the time, according to Olenski. There were other small blessings along the way: nurses that become friends, nights spent in their own beds.

“I’m very grateful we were able to have as much control over that experience as we ultimately did,” she said. “And there’s little things in there that we experienced that I would argue were just magical and special for us, in the folklore that now is going to become his story.”