National Nurses United

F atmeh kalaveras has spent almost 30 years as a bedside registered nurse and thought nothing could surprise her, but her hospital last year rolled out what until then was unimaginable to her: a nightmarish scheme to care for patients needing acute hospital care in their own houses. "It is an insult to nurses, to the nursing and all medi- cal professions, and even more worrisome, it is straight up dangerous for our patients," said Kalaveras, who saw the program firsthand when she worked as an emergency department nurse at Kaiser Permanente Medical Center in Vallejo, Calif. These remote programs, what nurses are calling "Home All Alone" schemes, are aimed at keeping patients needing acute care out of the hospital. Instead of admitting these patients, who would otherwise be traditionally hospitalized, they are sent home with an iPad and a smart- watch to be "admitted" for "hospital care" at their home. The patient is told a team of medical professionals will monitor them remotely from a medical hub. These hubs could be many miles away, or even in a differ- ent state, from the patient. From the hub, "care teams" are sent out to check on the patient as the need arises. In cases where a provider needs to physically be with the patient, the remote team will then send out a nurse or what they are calling an "upskilled paramedic." These Home All Alone schemes were born of an unholy alliance between a profit-driven hospital industry, technology giants, and ven- ture capitalists seeking to reap profits by replacing hands-on skilled hospital care with robots, gadgets, and less-skilled contract workers. "Labor is expensive and nurses have historically and continue to be undervalued for their professional expertise," said Michelle Mahon, RN and assistant director of nursing practice for National Nurses United. "Hospital and health care executives have long pushed an agenda to cut labor costs by slashing nursing budgets. And now they are taking it a step further, by putting patients in a sit- uation where they effectively have to care for themselves." While the hospital industry has for many years pushed to decen- tralize care away from the hospital and towards outpatient and telehealth programs, the pandemic provided an opening to promote, establish, and normalize these schemes on a much larger scale. In November 2020, as hospitals were overrun with Covid patients, the U.S. Centers for Medicare and Medicaid Services (CMS) waived sig- nificant regulations governing the provision of hospital care, making it feasible for hospitals to send acute-care patients to their own homes but still collect as much in CMS reimbursements as if they were housed at the hospital. Today, some 206 hospitals run by 92 systems in 34 states cur- rently have temporary CMS waivers to run these Home All Alone programs. The list grows by the week. "Nurses know that patients need us with them. Health care executives are trying to move us closer and closer to the day that medical professionals will no longer work in hospitals," said Mahon. "Patients will only have gadgets, unlicensed personnel, and even lay people with minimal training providing their 'care' in outpatient set- tings. These Home All Alone schemes set us on the path to this dystopian and dangerous future." T he concept of treating acute-care patients in their homes is not new and some large hospital systems such as Mount Sinai Medical Center in New York and Johns Hopkins 12 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G J A N U A R Y | F E B R U A R Y | M A R C H 2 0 2 2 Don't try this at home The national hospital industry is peddling programs to treat acute-care patients in their residences, instead of in the hospital where they belong. B Y R AC H E L B E R G E R A N D L U C I A H WA N G

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