National Nurses United

would easily be confused for a doctor, and that team is suggesting they return home, while a nurse is suggesting that they stay," said Mahon. "There is no way the patient would know that the team is not part of the hospital staff." With no professional nursing staff available 24/7 in patient homes, the burden of care inevitably falls upon members of the patient's immediate household—mostly likely laypeople with no medical education, knowledge, or training. Families often don't realize how cumbersome and difficult patient care is, said Kruta, even when it is relatively simple. Kruta recalled teaching one family member how to care for a wound. "When we tried to explain how to do it, the caregiver puked," she said. "Families want to help their loved ones," she added. They often feel unable to say they won't or can't provide the care. But then the reality of the task is often far more difficult than they had antici- pated. Family members who may have promised to help with care start falling away. "After a week of it, the novelty wears off, and mama may have a pressure sore, or worse." Caring for a patient at home also puts enormous strain on the entire household, especially the caregivers who are very often the women. "We hear it all the time," said Kruta. "They have a life, they have jobs, they have their own kids. They ask 'How am I going to take care of them?'" Data collected since the start of the pandemic shows clearly that women, and especially single mothers, suffer economic losses as their caregiving tasks increase. Nurses say it is easy to see how cal- ling on families to care for loved ones who need hospitalization will lead to a disproportionate increase in economic losses for women. In addition, nurses know the idea that family members can provide hospital-level care is absurd and unsafe. Registered nurses often serve as the last line of defense for patients against medical errors, especially in the area of medication administration. RNs are trained in the five rights when passing meds and discipline for medication errors can be severe. Yet hospitals, such as UC Irvine Medical Center in Irvine, Calif., write in documents submitted to the state health department support- ing its Home All Alone program that patients and family/caregivers can give oral, subcutaneous, intramuscular, and even intravenous medicat- ions if they are assessed on their knowledge and skills. A remote nurse is supposed to watch over video when oral medications are given and document in the electronic health record. Nurses are shocked by the nonexistent safety protocols for Home All Alone programs. Nurses are particularly distressed about what will happen to Home All Alone patients when they code. A patient's condition can go from bad to life threatening in just minutes. In a hospital, patients in distress can access surgery, specialized medications, a rapid response team, and much more. But how fast will the medical cavalry come for a patient alone at home? Importantly, they ask, will there be someone who will even notice that the patient is decompensating? Nurses know that sick patients are terrible at judging how ill they truly are, especially if they have altered cognition, as can happen with an infection and as a reaction to some medications, or illnesses. "A lot of people just believe they are fine and people minimize what is happening," said Genevieve Buttom, a registered nurse at Mercy General Hospital, in Sacramento, Calif. "I have seen a patient have a heart attack tell me they are fine. A lot of patients don't want to be a burden, they don't want to make a big deal." One Home All Alone program claims to have a fleet of vehicles with unspecified medical professionals who can arrive at a patient's home "within an hour." But nurses know that is entirely insufficient when dealing with an emergency. "How long is it going to take to get a paramedic to them?" worries Joyce Ball, an emergency room nurse in Chicago. "It only takes one minute for a blood clot to travel to the heart and lungs, so that one minute is a matter of life and death." Perversely, marketers and hospital executives wrap these schemes in the language of racial and social equity, claiming they will expand health care to Black and Brown, poor, and rural com- munities. They claim that treating acute-care patients at home allows medical providers to enter people's homes and address the social determinants of health that contribute to their illnesses, yet there's nothing preventing health care corporations from tackling those problems now. In reality, Home All Alone schemes pave the way for hospital clo- sures, and will exacerbate socioeconomic and racial health inequities. National Nurses United members say no to Home All Alone schemes and urge their patients and the public to not participate in these programs. NNU is on a mission to educate its members and the public to understand how these Home All Alone programs destroy nursing, destroy hospitals, and destroy safe care for patients and communities. On Nov. 10, 2021, Kaiser registered nurses across Northern Cali- fornia held more than 20 informational pickets to show their opposition to and warn the public about Kaiser's and other hospital systems' Home All Alone schemes. "Nurses and other health profes- sionals cannot be replaced by iPads, monitors, and a camera," said Deborah Burger, a president of NNU. "Our patients deserve much more than this and should flat-out reject Kaiser's program. To send patients home and call that 'hospital care' debases what hospital care means, endangers patients, and is an insult to patients, nurses, and all the many health care professionals who provide care in hos- pital settings." NNU's advocacy is already working. On April 5, Adventist Health and Rideout, which runs a hospital in the semi-rural community of Marysville, Calif., announced that it was pulling the plug on its Hos- pital@Home program after treating 194 patients over 15 months. For nurses, this is an encouraging sign. "If someone needs to be hospitalized, they need to be in an actual hospital and under the care of highly skilled, educated medical professionals who are able to touch, assess, monitor, and respond to critical and emergent situ- ations which can mean the difference between life and death," said Burger. "These programs are a blatant attempt to increase profits by sacrificing high-quality patient care." Rachel Berger is a communications specialist at National Nurses United and Lucia Hwang is editor of National Nurse magazine. J A N U A R Y | F E B R U A R Y | M A R C H 2 0 2 2 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 N A T I O N A L N U R S E 15 Learn more about these Home All Alone schemes •View our new animated video about such programs: https://vimeo.com/ 698268377/3d1a82bd40 •Attend a continuing education course about this trend: https://www.nationalnursesunited.org/ce-classes

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