This is both a brilliant and a horrifying idea: “Hospital-level care at home—some of it provided over the internet—is poised to grow after more than a decade as a niche offering, boosted both by hospitals eager to ease overcrowding during the pandemic and growing interest by insurers who want to slow health care spending.”

The reality when insurers say they want to slow spending is that they mean they want to put more of a burden on the consumer. Under many models, yes, this would certainly slow spending in hospital settings—where huge bills rack up fast. Kaiser Permanente and the Mayo Clinic are both looking at implementing at-home medical care for the moderately ill. That could include patients with “pneumonia or heart failure—even moderate covid,” who would get both 24-hour remote monitoring via the internet and daily visits from health workers, potentially even doctors.

The two healthcare behemoths estimate that 30% of the patients they currently admit could be treated at home and are investing in Medically Home, a Boston-based company, to expand their in-home care programs. Other hospitals are already trying it, including Johns Hopkins Medicine in Baltimore, Presbyterian Healthcare Services in New Mexico, and Massachusetts General Hospital.

For the patient and family, there could be some real advantages. Hospitals are full of sick and infectious people—keeping people out of the hospital can certainly help reduce hospital-caused infections. Being cared for at home is often less stressful for patients, which helps in the healing process. Kaiser Health News (KHN) links to studies that show “in-home care is just as safe and may produce better outcomes than being in the hospital, and it saves money by limiting the need to expand hospitals, reducing hospital readmissions and helping patients avoid nursing home stays.” It also can save as much as 30% over traditional hospital care, according to some estimates.

However, Gerard Anderson, a health policy professor at Johns Hopkins University Bloomberg School of Public Health, is cautious. “It’s realistic in middle- and upper-middle-class households,” Anderson said. “My concern is in impoverished areas. They may not have the infrastructure to handle it.” That works on both sides of the equation—homes have to be equipped with adequate internet access. They have to be geographically close enough to the providers to make daily visits possible. There has to be a family member or other person around who can provide back-up.

That’s a big rub. What the hospitals and insurers plotting all this out need to take into account is the people at home who are going to have to help make this happen. A 2019 study from AARP (formerly called the American Association of Retired Persons) details the amount of caregiving that has already been put on families: an estimated 34 billion hours, worth about $470 billion in unpaid care, provided by about 41 million family caregivers.

These are primary caregivers for adults who are elderly or disabled. The out-of-pocket costs for caregivers average about $7,000 annually, which includes spending on home modifications, on medications and medical equipment, and on personal supplies. Insurers and hospitals are almost certainly looking at putting the costs of lots of supplies—laundry and home-cleaning supplies, wound care supplies, protective gear like gloves and masks when necessary. And how much of the care that is supposed to be provided by visiting professionals is going to be pawned off on family members?

From personal experience, that could be a lot. I helped care for a family member being treated for cancer a few decades ago. Keeping him out of the hospital as much as possible was a goal because his heavy-duty chemo treatments completely wiped out his immune system. At one point he was supposed to be receiving antibiotic infusions at home, provided by a visiting nurse. It was a complicated procedure using the chemo port inserted in his chest, one that the nurse determined they didn’t need to do. They showed us the procedure once, left us with all the equipment, and basically said “good luck.” We did it, but it was a lot to add on top of the already dire situation.

KHN talked to one patient who was cared for at home as opposed to in the hospital for an infection. James Clifford in Bakersfield, California, said there were some complications in coordination: His wife was supposed to be at home for the team that was setting up his care at the same time she was supposed to be picking him up from the hospital. The 70-year-old Clifford said that despite that, “once it was set up, it worked well.”

He had to get his antibiotic infusion every eight hours, and “one nurse came at 2 a.m.,” said Clifford. “It woke up my wife, but that’s OK. We had peace of mind by my being at home.” KHN didn’t interview his wife to determine whether it was all okay with her.