Dr. Jared Conley at home with his family while receiving intravenous antibiotics

Dr. Jared Conley

The Hospital-at-Home (HaH) model under Medicare lets patients receive hospital-level care at home instead of a traditional, brick-and-mortar hospital. But when the waiver funding the program expired on September 30, 2025, hospitals and patients were left navigating a far less efficient system.

Last week, one of my elderly patients, who is typically admitted via HaH for heart failure exacerbations, was disappointed to learn she had to stay overnight in the hospital before returning home. Like many patients across the country, she waited in an overstimulating emergency department for 20 hours before getting to her inpatient room.

“Patients often ask me, ‘Doc, when can I go home?’ That is the constant refrain,” says Dr. Jared Conley, Assistant Professor at Harvard Medical School and co-chair of the US-based Hospital at Home Tech Council. “The experience at home is a healing environment — sleep is tenfold better and patients feel more autonomous.”

Some of the larger HaH programs see 100 patients a day. Beyond patient comfort, Conley notes that HaH reduces inpatient census and eases bottlenecks in emergency departments, underscoring its system-wide value.

Yesterday, Congress reinstated the program through January 2026, offering temporary relief and retroactive reimbursement. Still, the recent lapse highlights a deeper truth: the U.S. health-care system relies heavily on home-centered acute care, and with an aging, increasingly complex population, hospitals have little capacity to absorb demand when the program pauses.

Development of Hospital at Home

Conley explains that HaH has been in development for decades, thanks largely to pioneers like Dr. Bruce Leff who, in the 1980s and 1990s, recognized that their patients’ health suffered beyond the medical issues being treated. “The hospital environment itself was taking a toll,” Conley says. Early innovators sought to provide acute care to seniors in the comfort of their homes.

As pilot programs expanded, funding was scarce and often patchwork, but research consistently demonstrated the model’s benefits. In 2014, Mount Sinai received a large Centers for Medicare and Medicaid Services Innovation grant to evaluate HaH. Their research showed improved clinical outcomes, faster recovery, and lower readmission rates.

Even with these promising results, widespread adoption remained slow.

That changed during the COVID-19 pandemic, when hospitals struggled with unprecedented capacity challenges. CMS issued a waiver allowing hospitals to be reimbursed for HaH if they could demonstrate patient safety. “Over the last five years, 400 hospitals have applied for and received the waiver,” Conley notes, adding that “there is a bill in Congress now to extend funding for another five years.”

As of October 2024, 366 hospitals have served over 31,000 patients via HaH —a sign of growing national momentum.

The Hospital at Home Patient Experience

Though Dr. Conley has spent the last decade advancing Hospital at Home, he only recently experienced the clinical alternative firsthand. On November 1, he sustained a crush injury to his foot while mountain biking. Within days, the wound became infected and the redness began creeping up his leg. Oral antibiotics improved the leg but not the foot. After several days without progress, he went to the emergency department and received intravenous antibiotics.

Because his injury occurred after the September 30th, 2025 lapse of the HaH waiver, Conley was admitted overnight before being able to transfer home for further care. The clinical care was strong while inpatient, he told me, but the hospital environment, like most hospitals, was not patient-friendly. “There were overnight alarms, 4 a.m. blood draws, and a lack of privacy,” all of which made rest and recovery harder.

After one night inpatient he transitioned home and continued intravenous antibiotics using the same line placed in the hospital. “I got to enjoy all the comforts of home and had two visits daily by the team,” he said. His infection has since significantly improved.

Hospital-at-Home programs provide much of the same care delivered in brick-and-mortar hospitals—oxygen support, cardiac monitoring, labs, intravenous fluids and medications, X-rays and ultrasound, physical and occupational therapy, and case management and social work services.

But Conley notes a profound difference: the home setting gives clinicians a far deeper understanding of a patient’s real life. “You learn so little about patients when they’re guests in the hospital,” he said. “But when you go to their home, you see their inequities. Their social determinants of health become visible, and the team can use that insight to add more services and support.”

Normalizing HaH for patients and clinicians

Conley believes that he has witnessed clinicians, nurses, physician assistants, paramedics, and physicians, for instance, have decreased burnout working outside of the traditional hospital system. He believes in one key driver: “Patients tell us thank you. They say, ‘Thank you so much for coming to my house,’” and that appreciation is critical for a sense of purpose.

Some patients remain hesitant about HaH, largely due to fear of the unknown. As Dr. Jared Conley explains, “Some people think, ‘If I’m sick, I need hospital-level care.’” Decisions can become complicated when the patient and clinical team prefer home, most family members agree, but one unfamiliar relative objects. A minority also worry about strangers entering the home or adding burden to caregivers.

But research — and experience — show these concerns are usually outweighed by the realities of inpatient care. Conley notes that caregivers do take on routine tasks of daily living, “things they would normally do, nothing medical,” but these are far fewer burdens than those created by hospitalization, such as restricted visiting hours, long travel, or parking. Caregivers are not asked to provide medical care that would otherwise be provided by a hospital team. “Caring for someone is always work,” he says, “but compared to the hospital experience, most caregivers prefer home.”

Scaling the Model and Future Challenges

Dr. Conley said the biggest barrier to expanding Hospital-at-Home is uncertainty around payment and legislation. “Lack of certainty in the payment model is the key issue,” he notes. HaH also challenges physician and patient culture and tradition, requiring trust in a system where lives are on the line.

He also emphasized the demographic imperative: “People over 65 will double in 20 years. We don’t have enough hospital beds to meet that demand.” Building new hospitals is a difficult solution. “We need to allocate brick-and-mortar care to those who truly need it. The rest can receive hospital-level care safely at home.” Conley adds that when management of his acute care was transferred home, his inpatient bed could be given to another patient waiting in the ED.

The Future of Hospital-at-Home

HaH programs rely on advanced monitoring and integrated technology to ensure patient safety. Conley works with “startups, the FDA, and large companies to build technologies to further de-risk patients at home.” Currently, 5–7% of patients return to the hospital, rarely due to rapid deterioration, though ongoing research seeks to detect complications even earlier.

This month’s continuing resolution restores HaH funding through January 30, 2026. While clinically and economically sound, long-term authorization is needed to avoid wasting a model that is safer for patients, more efficient for hospitals, and sustainable for Medicare. HaH is no longer experimental—it is evidence-based, patient-centered, and growing in adoption. As Dr. Conley’s experience shows, it often delivers simply better care. Temporary reinstatement is a start, but data indicate a permanent pathway is the future.