I am writing in response to "At-Home Hospital Care Reduces Readmissions and Length of Stay, Enhances Patient Satisfaction" (In the News, October 2018). While I can appreciate the idea of expanding acute-level hospital-quality care in the home as an alternative to hospital admission, as an RN working in the home care field, I have concerns.

Although the article states that candidates for this type of care are stable enough to be cared for at home, it also states that they are sick enough to be hospitalized. Patient stability can change quickly. Hospitalized patients have emergency responders close by, but what happens if a change in stability happens at home? I recommend providing further information regarding emergency protocols, as well as elaborating on what makes an ideal candidate for at-home hospital care. Patients who fall in the middle of the acuity spectrum are the best candidates.1 Careful identification of these patients is key.

Additionally, citing the lack of a payment mechanism as the chief barrier to implementing at-home hospital care-when there is a clear safety issue present-suggests that money is the main concern. Let's face it: when it's all about the money, patients are not the biggest winners. While I like the idea of further expanding nursing care beyond the hospital setting, I want to make sure that we are still acting in the best interest of our patients.

Torey Sippio-James, BSN, RN

El Paso, TX

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