Hospital at Home: What Healthcare Administrators Need to Know

Hospital at Home is a care delivery model that allows some patients to receive acute, hospital-level care in their homes, as opposed to in a brick-and-mortar hospital setting. The modern concept dates back to 1947, when a home care program at New York’s Montefiore Hospital extended hospital services into patients’ homes, in order to relieve overcrowding. Across the Atlantic, France introduced a formal hospitalisation à domicile service in Paris in 1957, legally recognizing the model in 1970. Variants then developed across the UK and other European countries.

It took until the 1990s for the US to formalize its own acute-care model, which became the foundation of Hospital at Home. While it slowly gained traction in the US, payment and logistics challenges remained a major obstacle. Covid-19 changed everything. Hospitals peaked well beyond capacity. In November 2020, CMS launched the Acute Hospital Care at Home waiver, and Hospital at Home entered the mainstream.

The public health emergency has ended, but Hospital at Home is still here. The reason is that it works. With an aging population, Hospital at Home is an important lever in extending capacity; more people in the US want the center of their healthcare to be home.

In February 2026, Congress extended Medicare’s Acute Hospital Care at Home waiver through September 2030. Hospital at Home is written into the future of care.

Dr. Eliza Shulman is the immediate past president of the American Academy of Home Care Medicine (AAHCM) and the chief medical officer at DispatchHealth. She joined DispatchHealth’s leadership team during the company’s merger with Medically Home, where she had served as chief medical officer and chief strategy officer.

Dr. Shulman earned her DO from the University of England and her MPH from Dartmouth College. She is triple board-certified: in family medicine, preventive medicine, and hospice and palliative medicine.

“People don’t realize how well-studied Hospital at Home is,” Dr. Shulman says. “There’s a lot of evidence behind this model.”

Hospital at Home is different from traditional home health, where patients have already had their hospitalization. Hospital at Home is for patients who would otherwise be in a brick-and-mortar setting. Think of someone with an acute exacerbation of a chronic disease such as pneumonia. Instead of receiving that treatment in a brick-and-mortar hospital, they receive it—along with all the monitoring, intravenous therapies, and meals—in the comfort and safety of their home.

Traditional hospitals have grown and changed beyond their original intentions. While they’re ideal for life-saving interventions and intensive care, they’re not necessarily ideal for every patient who needs treatment for an acute illness. Older patients, especially, are at risk when they’re moved outside of the home for care. Delirium rates are high. Hospitalization can have unintended consequences, like hospital-acquired infections.

“When you hospitalize someone in their home, you begin to reduce or avoid some of those unintended consequences,” Dr. Shulman says. “We see that in the evidence. The clinical outcomes of home hospitalization are very similar to traditional hospitals, meaning patients do very well. They recover from their illnesses in a similar time frame. They have the same or often even lower readmission rates. In most cases, they require less post-acute care.”

Traditional hospitals have a huge capacity problem. Part of the reason is demographic: the Baby Boomers are aging, and the US population is aging with them. That’s creating higher hospitalization rates and an increase in hospital stay duration, especially among patients with chronic conditions (AHA 2026). 

“As the population ages, we’re going to need more hospital capacity,” Dr. Shulman says. “But we don’t have beds for those patients. The beds we do have are unevenly distributed.”

Capacity issues are hard to build your way out of. UC Davis’s California Tower will cost $11 million for each of its 332 inpatient beds, and take at least 6 years to complete; Penn Medicine’s Pavilion cost $3.2 million for each of its 504 patient rooms. Even if capacity could be rapidly built to meet all the nation’s hospitalization needs, new problems might arise as demographics swing the other way in the coming decades. 

“We need to build sensibly,” Dr. Shulman says. “Hospital at Home offers the opportunity for dynamic capacity. And because it doesn’t require capital expenditure in the same way that building a new hospital does, it has a very favorable expense outlook.”

Hospital at Home isn’t free. It requires sending professionals into patients’ homes. It requires high-tech virtual monitoring. In an apples-to-apples comparison, Dr. Shulman says, the costs of Hospital at Home and traditional hospital care are in many ways similar. But as Hospital at Home programs scale, the math gets better and better.

“The real advantage of Hospital at Home comes in the downstream savings to a system,” Dr. Shulman says. “There will be some savings off the top in capital expenditure, and then some in care delivery, but most of it will come from post-acute care and readmission savings.”

For years, Hospital at Home was obstructed from wider adoption by a lack of payment options in the US. It was a buzzy idea in healthcare, but still relatively small, with some projects funded by CMS, some funded by Medicare Advantage, and some by the VA. Then, during Covid-19, CMS waived two of the Medicare conditions of participation, allowing payment for hospital care at home. 

“It was a simple shift: that the site of service did not matter for hospitalization, as long as hospitals were able to meet the criteria of the hospital,” Dr. Shulman says. “When CMS passed that waiver, they thought 10 or 20 hospitals would take advantage. Within a few months, over 100 had applied. By 2022, it had spread to 250 hospitals across the country.”

After the waiver, payment became easy: providers didn’t have to screen patients for eligibility, only clinical stability. The two-year waiver was extended twice. As of January 2026, 40 states had waivers in place through different systems. 

“As more patients began to experience the model, the evidence base grew,” Dr. Shulman says. “There had been a trickle of evidence worldwide and in the US, but now we had randomized controlled trials. In the last five years, there have been dozens of papers published showing that Hospital at Home is safe, is effective, and that patients love it.”

Healthcare teams are gaining more experience with Hospital at Home, too. More patients are asking about it. A culture change is taking place. 

“We’re still not at the tipping point,” Dr. Shulman says. “This is not the standard of care at every hospital in the country. But when I go and talk about it now, I don’t need to convince people. They already know Hospital at Home works. Their questions are: Does my hospital system need this? Is it financially a good idea for us? That’s a very big shift from five or six years ago.”

Healthcare systems are increasingly fragile. Their margins are thin. Hospital at Home is still an innovation, and it needs some wiggle room to be adopted. Most of all, it needs to fit the healthcare system’s strategic priorities. 

“For healthcare systems that are the most open to Hospital at Home, the factors they’re looking at are capacity and competitive edge,” Dr. Shulman says. “This model gives them a differentiated patient experience. It helps with readmission prevention. But you need to make sure you have champions in your healthcare system who are going to carry this forward.”

Those champions are needed in leadership and on the front line, with both working together. Transitioning to Hospital at Home is a major operation: everything a patient would need in a traditional hospital needs to be in their home, or deliverable in a timeframe similar to what they’d experience in a hospital. That creates a tricky logistical puzzle of ordering and fulfillment. Dr. Shulman likens the transition to building a new hospital wing or launching a new service line. It can take four to six months to complete. 

“It’s work,” Dr. Shulman says. “You need to establish a care delivery network in the home. You need clinicians who know how to take care of patients who are acutely ill in the home—that’s a unique skill set, and it’s non-negotiable. The remote patient monitoring technology is a much easier lift, but it’s what ties everything together. You can run a small program on an Excel spreadsheet or Post-It notes, but eventually, you’re going to have to automate in order to grow.”

In February 2026, Congress renewed CMS’s Acute Hospital Care At Home waiver through September 2030. With the runway extended, more health systems are showing interest. Wider adoption will lead to more data on Hospital at Home patients, boosting research and informing proposals for a permanent payment plan in Congress. The future of Hospital at Home is more secure than it’s ever been in the US. 

“To me, the future is that Hospital at Home is widely available, in all 50 states, wherever patients want it,” Dr. Shulman says. “More and more programs will open and scale, so that it’s available to every patient, no matter who their payer is. It’s a great model. It’s safe and effective. Patients, families, and caregivers really love it.”

Matt Zbrog

Writer

Matt Zbrog is a writer and researcher from Southern California. Since 2018, he’s written extensively about emerging issues in healthcare administration and public health, with a particular focus on progressive policies that empower communities and reduce health disparities. His work centers around detailed interviews with researchers, professors, and practitioners, as well as with subject matter experts from professional associations such as the American Health Care Association / National Center for Assisted Living (AHCA/NCAL) and the American College of Health Care Executives (ACHCA).