Hospital at home is changing where acute healthcare can safely be delivered. At VCU Health, eligible patients admitted through VCU Medical Center can receive hospital-level treatment in their own homes through a combination of in-person visits, virtual physician care, nursing support and coordinated services. For patient Ericka Akoto, who was treated for fluid buildup associated with congestive heart failure, the model provided both medical support and a more personalized recovery experience.
VCU Health launched its Hospital at Home program in 2023 and has since provided hospital-level care to more than 1,000 people across the Richmond region. The organization says it was the first hospital in Central Virginia to offer this type of program.
Hospital at Home Brings Acute Care Closer
Akoto sought treatment at VCU Medical Center after experiencing swelling caused by fluid accumulation in her leg and foot. After hospital staff determined that her ongoing treatment could be managed safely outside a traditional hospital room, she was offered enrollment in VCU Health’s Hospital at Home program.
The model does not simply discharge patients early and leave them to manage independently. Eligible participants remain hospital patients while receiving acute-level services in their homes.
Dr. Julia Breton, co-medical director of the program, said patients may sleep, eat and move better at home than during a conventional hospitalization. These everyday factors can become important components of recovery.
Hospital at Home Combines Virtual and In-Person Care
VCU Health patients enrolled in the program receive daily virtual physician visits and two in-person visits from members of the medical team each day. They also have access to 24/7 virtual nursing support.
Depending on individual needs, services can include:
- Laboratory testing
- X-rays and ultrasound
- Oxygen therapy
- IV medications
- Skilled nursing
- Physical and occupational therapy
- Meals and nutrition services
- Transportation assistance
- Pharmacy delivery and coordination
This combination allows patients to receive significant clinical support without remaining inside a hospital building.
Personalized Care Supports Patient Recovery
One of the major advantages of delivering care in a patient’s home is the ability to understand the environment where recovery actually occurs.
Hospital clinicians usually see patients in standardized rooms. Home visits provide information about mobility, medication organization, family support and everyday obstacles that may not be visible during an inpatient stay.
Akoto described the home-based experience as more focused because clinicians could spend one-on-one time with her without the distractions associated with a busy hospital environment.
Hospital at Home Reveals Everyday Challenges
The value of that visibility became clear when a physical therapist observed Akoto struggling to rise from her favorite couch.
Akoto had experienced two strokes in recent years, making movement around her home more difficult. The therapist recommended a cushion that helped her sit higher and handles near the couch armrest that she could use for support.
This relatively simple intervention demonstrates why home-based care can reveal problems that may be difficult for patients to explain during a hospital stay.
Clinicians can also help organize medications, set up medical equipment and teach patients how to use equipment in the exact environment where it will be needed after formal hospital-level care ends.
Home-Based Care Can Strengthen Relationships
VCU Health nurse Chris Walker noted that home visits allow clinicians to focus completely on one patient rather than simultaneously caring for several people on a hospital floor.
That dedicated time can support communication with both patients and family members.
Home-based clinicians can see how a patient actually manages daily routines and work with families on practical solutions. This may make the eventual transition out of acute care more manageable because discharge planning takes place within the patient’s real living environment.
The objective is not to transform a home into a miniature hospital. Instead, the program brings the necessary hospital capabilities to the patient while preserving the familiarity of home.
Hospital at Home Requires Careful Eligibility
Home-based hospitalization is not appropriate for every patient.
VCU Health requires participants to need active hospital-level treatment while remaining clinically stable and at relatively low risk for complications. Their condition must be manageable safely outside the hospital, and they must live within 25 miles of VCU Medical Center.
Patients may be evaluated for the program while already admitted to VCU Medical Center or while awaiting admission through the emergency department.
These eligibility rules are essential because hospital-at-home programs still carry responsibility for delivering acute inpatient-level care.
Hospital at Home Maintains Clinical Oversight
The wider federal model also includes substantial monitoring requirements.
CMS launched its Acute Hospital Care at Home initiative in November 2020, allowing approved Medicare-certified hospitals to deliver inpatient-level services at home under specific requirements. Participating hospitals report safety and quality information to CMS and must follow patient-selection and monitoring standards.
Congress has extended the federal program’s waivers and flexibilities through September 30, 2030, providing additional runway for hospitals and policymakers to evaluate the model.
Hospital at Home Expands Patient Choice
Hospital at home represents more than a change in physical location. It creates another option for delivering acute care to carefully selected patients.
For health systems, the approach may provide a way to extend hospital capabilities beyond traditional facilities while maintaining structured clinical oversight.
For clinicians, entering a patient’s home provides information about daily life that may improve discharge planning and recovery support.
For patients like Akoto, the difference can be highly personal. Receiving treatment in a familiar environment while having focused access to nurses, physicians and therapists helped create a sense that her individual needs were receiving greater attention.
The model will continue to require careful patient selection, reliable technology, rapid escalation pathways and strong coordination between virtual and in-person teams. But VCU Health’s experience illustrates how hospital at home can combine acute medical treatment with a care environment designed around how patients actually live and recover.
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