In October, Kaiser Health announced plans to bring hospital-level services to patients in the comfort of their homes. The company, along with Mayo Clinic and the firm known as Medically Home, will use remote patient monitoring to increase access to care, but nurse unions say this will rob patients of the true hospital experience. If their condition deteriorates rapidly at home, they may not have access to vital in-person services that could save their life.
The At-Home Model
In the face of the COVID-19 pandemic, many health systems have started pivoting to at-home care. Patients have shown an interest in meeting virtually with providers. They don’t have to travel long distances to get the care they need, which can be an asset in rural areas.
Congress recently expanded telehealth coverage during the pandemic to ease the strain on health systems, but these regulations will likely go away when the public health emergency ends.
However, Kaiser is betting that the trend continues.
The company, which employs over 63,000 nurses nationwide, recently invested in Medically Home to increase its share of the market. It launched a “virtual first” program in Washington state earlier this year, which uses telehealth as a foundational modality of care.
Kaiser is currently piloting two telehealth programs in California, but it plans to extend these services nationwide.
Dr. Michael Maniaci, a representative of the company, says offering hospital-level care at home can reduce readmission rates and the rate of infection among chronically ill patients. Kaiser also says patient satisfaction levels were high.
Not everyone is on board with this program. Just last week, National Nurses United, the largest nurses’ union in the country, along with the California Nurses Association released a joint statement opposing the shift to virtual care.
They accused the company of trying to maximize profits, while putting patients at risk and undermining the role nurses play in primary care. The statement also says that the program would shift the burden of care onto laypeople, usually women, with the potential to exacerbate racial inequities.
“Nurses, more than any other healthcare staff, spend the most time with patients,” the unions said in the statement.
“We reject Kaiser’s assertion that iPads, cameras, monitors, and the occasional visit by likely lesser-skilled and unlicensed personnel are in any way comparable to the skilled, expert nursing care and social emotional support we RNs provide every moment of every shift,” they added.
Kaiser quickly defended the program by putting out its own statement.
“Nurses have always and will continue to play a critically important and highly valued role at Kaiser Permanente. The Advanced Care at Home Program does not limit the role of nurses in hospitals,” said the company. “The Kaiser Permanente Advanced Care at Home is an innovative person-centered program rooted in quality, safety and patient satisfaction. Patients enrolled in the program must meet established clinical and safety criteria.”
“Regardless of whether the patients are receiving care in the comfort of their own home or in a hospital we hold ourselves to the same high standard of care. The program empowers multidisciplinary care teams to provide the right care at the right time while meeting our patients where they want to be,” the representatives added.
The unions also claimed at-home care would rob patients of the benefits of being close to specialized treatment centers.
“Nurses know that our patients can be fragile and their condition can deteriorate quickly and unexpectedly. We are appalled by the idea that our patients could be stranded at home in case of an emergency or adverse event, with no way to get immediate help or medical intervention and treatment,” said the statement.
They were also skeptical of the program’s reported patient outcomes, considering it has only been implemented at two California facilities. The unions also referred to the program as a potential “gold mine” for Kaiser.
“The industry will accuse registered nurses of opposing this and similar programs because we simply want to ‘keep our jobs,'” the statement reads.
“That’s exactly right. Hospital nurses do want to keep our jobs because we know our profession serves a critical role in our society: We are highly educated, knowledgeable, and skilled professionals who care for the sickest of the sick with our healing touch. We practice the art and science of nursing, and all patients must have equal access to our care,” it continued.
Finally, the unions pleaded with the public to invest in in-person care instead of relying on unproven technology.
“Registered nurses are demanding that the hospital industry, the public, and private and government payers such as the Centers for Medicare and Medicaid Services abandon these plans to send home patients who should be admitted to hospitals,” the unions added.
“As a country, we need to invest in the proven health care infrastructure and RN workforce we know we need – and that our current COVID-19 pandemic painfully reconfirms we must have – to care for the nation’s patients,” it continued.