Hospital-at-home
Professional services
UnclaimedHospital-at-home is a healthcare delivery model that provides acute, inpatient-level treatment in a patient's residence rather than in a conventional hospital.
Last updated November 4, 2026
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Overview
Hospital-at-home is a healthcare delivery model in which patients receive acute, hospital-level treatment in their own homes instead of occupying a bed in a traditional licensed hospital. It is distinct from routine home care, domiciliary nursing, and historical physician house calls because it is intended to substitute for an inpatient admission or to complete an admission after a patient has been assessed in an emergency department or hospital. Depending on the jurisdiction, the model is also called home hospital, hospital in the home, virtual hospital, or virtual ward. The model combines in-person clinical visits, remote monitoring, telehealth, diagnostics, medication delivery, equipment, care coordination, and rapid escalation pathways. Patients are generally selected through clinical and social screening. Programs assess the diagnosis and required intensity of care, the safety and suitability of the home, available utilities, caregiver capacity, transportation, and the risk that the patient may need immediate transfer to a conventional hospital. Once admitted, patients may receive daily visits from registered nurses, physicians, paramedics, or other clinicians. Physicians can conduct consultations in person or through telehealth, while connected devices transmit vital signs and other observations to a clinical team. Programs are also expected to provide an on-demand route to staff and emergency transport when a patient's condition exceeds what can safely be managed at home. The principal arguments for hospital-at-home are improved patient experience, reduced exposure to hospital complications, preservation of hospital capacity, and potentially lower costs. Early research associated with Johns Hopkins found that selected older patients treated through a home-hospital pilot had comparable or better outcomes, higher satisfaction, and costs substantially below conventional inpatient care. Later evaluations in the United Kingdom, the United States, and elsewhere have continued to report favorable results for carefully selected populations, although outcomes and economics vary according to staffing, technology, transport, reimbursement, and the conditions treated. Modern hospital-at-home programs developed from earlier home-based medical services but gained particular momentum in the late twentieth century. Johns Hopkins physicians John Burton and Donna Regenstreif helped advance the modern American concept in the 1990s. In the United Kingdom, the 2006 Croydon virtual ward pilot pioneered by Geraint Lewis helped establish a model for managing patients who were at risk of hospital admission or readmission. The COVID-19 pandemic accelerated adoption worldwide. Health systems used virtual wards and home-based acute care to monitor patients outside crowded hospitals, while advances in telehealth and connected monitoring made it easier to supervise care remotely. Implementation differs substantially by country. Australian services are often described as hospital in the home. The United Kingdom's National Health Service generally uses the term virtual ward. Singapore's National University Health System developed NUHS@Home after research into public acceptance of hospital-at-home care. Hospital Clínic de Barcelona has operated a regional home-hospital service since the 1990s. Ireland has experimented with remote virtual-hospital care for geographically isolated populations, including Clare Island. Saudi Arabia's Seha Virtual Hospital, established by the Ministry of Health in Riyadh in 2022, connects a large network of conventional hospitals and was recognized by Guinness World Records as the world's largest virtual hospital. In the United States, the Centers for Medicare and Medicaid Services created the Acute Hospital Care at Home initiative in November 2020 under temporary waivers associated with the COVID-19 public health emergency. The waivers allowed participating hospitals to satisfy selected hospital participation requirements without maintaining continuous bedside nursing in the home and without treating the residence as a conventional hospital building. Participating institutions still had to meet requirements concerning patient consent, twice-daily in-person visits, clinical screening, diagnostics, medications, equipment, emergency response, coordination, and reporting. Congressional extensions were required because reimbursement depended on the continuation of the waiver authority. The approach remains controversial. Critics, including National Nurses United, argue that the absence of permanent on-site clinical staff can expose patients and families to avoidable risk, shift hospital work onto informal caregivers, and enable health systems to reduce costs without guaranteeing equivalent safety. Operational challenges include medication errors, caregiver workload, delayed recognition of deterioration, limited access to specialist procedures, and the need for reliable broadband, utilities, transportation, and emergency transfer. Hospital-at-home is therefore best understood not as a single commercial brand or standardized product, but as a family of regulated clinical operating models whose quality depends on patient selection, staffing, technology, escalation procedures, and payment policy.
History
Hospital-at-home developed from older forms of home-based medical assistance, including physician house calls and home nursing, but its defining idea is more specific: selected patients can receive the intensity and organizational status of inpatient care while remaining in a residence. The model requires a coordinated clinical service rather than an isolated home visit. It typically includes admission criteria, physician oversight, nursing care, diagnostics, medication administration, equipment, monitoring, communication, and a means of returning the patient to a conventional hospital if deterioration occurs. The modern concept gained visibility in the United States during the 1990s. Johns Hopkins School of Medicine is widely associated with the development of a structured home-hospital model. Physician John Burton, working with Donna Regenstreif of the John A. Hartford Foundation, helped formulate the idea in 1995 as a way to provide elderly patients with hospital-level treatment in familiar surroundings. A Johns Hopkins pilot involving Medicare beneficiaries with conditions including heart failure, pneumonia, and cellulitis was evaluated in the late 1990s. The small study reported lower costs, similar or better clinical outcomes, and greater patient satisfaction, encouraging further research. At the time, however, hospitals faced major barriers because insurers generally could not reimburse a home admission as an inpatient stay. The United Kingdom developed a related but somewhat broader pathway through virtual wards. In May 2006, Croydon Primary Care Trust launched a pilot associated with public-health registrar Geraint Lewis. The Croydon model focused on identifying patients at risk of admission or readmission and managing them through coordinated community care and monitoring. Its reported results supported the creation of similar NHS programs during the following decade. The terminology later shifted toward virtual wards, especially where services combined remote observation with community visits rather than reproducing every feature of a conventional inpatient unit. Other countries developed their own variants. Australian providers commonly use the term hospital in the home. Hospital Clínic de Barcelona reports operating a hospital-at-home program in Catalonia since the 1990s. In Ireland, physician Derek O'Keeffe introduced a virtual-hospital program on Clare Island in the late 2010s, using connected devices to monitor residents with chronic conditions and reduce unnecessary travel to the mainland. In Singapore, research involving patients at National University Health System hospitals found broad interest in the model, and NUHS subsequently introduced NUHS@Home. The COVID-19 pandemic was the major recent turning point. Hospitals needed ways to preserve beds, reduce exposure to infection, and monitor patients outside crowded emergency departments and wards. Improvements in telehealth, mobile connectivity, remote vital-sign devices, logistics, and home diagnostics made wider deployment feasible. In the United Kingdom, specialized COVID-19 virtual wards were created. In the United States, the Centers for Medicare and Medicaid Services first introduced the Hospital Without Walls program in 2020 and then established the Acute Hospital Care at Home initiative in November of that year. The latter permitted participating hospitals to use waivers from selected Medicare Conditions of Participation, including requirements linked to constant on-site nursing and the physical characteristics of hospital premises. The United States program required more than simply sending a patient home. Hospitals had to screen patients for clinical suitability and home safety, secure informed consent, arrange admission from a hospital or emergency department after physician evaluation, provide diagnostics and treatment, make medicines and equipment available, conduct at least two in-person visits each day, maintain continuous remote access to clinical staff, and report operational and safety data. Because the authority was connected to federal emergency and appropriations legislation, reimbursement became vulnerable to legislative delays and government shutdowns. Congress extended the authority through the end of 2024 in the Consolidated Appropriations Act of 2023. The reference material also describes a further five-year extension to September 2030 in legislation enacted in February 2026; that later development should be independently checked before being treated as settled historical information. Evidence from the United States and United Kingdom has generally supported the model for carefully selected patients. A 2023 VA Boston Healthcare System study reported lower costs and fewer complications in a hospital-in-home trial. Research from West Hertfordshire Teaching Hospitals NHS Trust reported lower average cost per bed day, shorter acute-treatment time, and high patient-reported safety and preference. These findings do not establish that hospital-at-home is appropriate for every condition. Programs must manage medication adherence, caregiver burden, unreliable utilities or connectivity, limited access to procedures, and the risk that deterioration may go unnoticed between visits. Labor organizations and other critics have therefore challenged the safety and policy implications of the model. National Nurses United has argued that patients and families may be required to perform work normally carried out by hospital staff, while hospitals may use home treatment to reduce overhead and physical bed capacity. Supporters respond that the model can offer more individualized care, reduce hospital-associated harms, and expand capacity when it is properly staffed, monitored, and regulated. Hospital-at-home remains an evolving family of clinical delivery systems rather than a uniform global service.
- 2023
United States appropriations legislation extends AHCAH
[1]The Consolidated Appropriations Act of 2023 extended the federal waiver authority through the end of 2024.
- 2022
Saudi Arabia establishes Seha Virtual Hospital
[1]The Saudi Ministry of Health launched a national virtual hospital service in Riyadh, later linking it with a large network of conventional hospitals.
- 2020
United States Hospital Without Walls and AHCAH policies begin
[1]Federal COVID-19 measures created the policy foundation for reimbursed acute hospital care delivered in patients' homes.
- 2006
Croydon launches a virtual ward pilot
[1]Croydon Primary Care Trust introduced a virtual ward associated with Geraint Lewis, helping establish a model later adopted by other NHS organizations.
- 1999
Johns Hopkins publishes pilot findings
[1]A study of a 1996–1998 pilot reported lower costs, comparable or better outcomes, and higher satisfaction among selected Medicare beneficiaries treated at home.
- 1995
Modern Johns Hopkins home-hospital concept develops
[1]John Burton and Donna Regenstreif helped formulate a structured home-hospital approach for older patients, contributing to the modern American hospital-at-home movement.
Products and positioning
A hospital-substitution and hospital-capacity model positioned around acute clinical care in the home, remote monitoring, patient-centered recovery, and potentially more efficient use of healthcare resources.
Federal hospital-at-home reimbursement and waiver program · 2020
Acute Hospital Care at Home
The United States CMS initiative permits qualifying hospitals to provide acute inpatient-level services in residences under waivers from selected Medicare hospital requirements. Programs must conduct clinical and home-safety screening, obtain consent, provide regular in-person visits, maintain remote clinical access, supply treatment and equipment, and report outcomes. It is a regulatory and operating framework rather than a consumer-facing product.
Public healthcare service model · 2006
NHS virtual wards
NHS virtual wards use remote monitoring, community-based clinical visits, and escalation pathways to manage patients who would otherwise require hospital admission or continued inpatient observation. Implementations differ by trust and diagnosis, but commonly combine connected devices with nursing, medical, therapy, and coordination services.
Hospital-at-home program
NUHS@Home
NUHS@Home is the National University Health System's Singaporean hospital-at-home offering. It emerged after research into patient interest in home-based inpatient care and uses a combination of clinical visits, remote monitoring, and hospital support to allow selected patients to receive treatment outside a ward.
Virtual hospital network · 2022
Seha Virtual Hospital
Seha Virtual Hospital is a Saudi Ministry of Health service based in Riyadh. It supports remote healthcare delivery and consultation across a broad network of hospitals and has been described as the world's largest virtual hospital by Guinness World Records.
Brand decisions
2023
Congress extends the AHCAH waiverStrategyBackground
The temporary United States hospital-at-home authority was approaching its scheduled expiration, while providers reported continued interest in using home-based acute care.
Action taken
The Consolidated Appropriations Act of 2023 extended the program through the end of 2024.
Aftermath
Hospitals received additional time to operate and evaluate programs, although long-term reimbursement remained dependent on further federal action.
2022
Saudi Arabia builds a national virtual-hospital networkStrategyBackground
The Saudi Ministry of Health sought to expand remote clinical access and connect specialist capabilities with hospitals across the country.
Action taken
The ministry established Seha Virtual Hospital in Riyadh and developed links with a large number of conventional hospitals.
Aftermath
The service became a prominent example of national-scale virtual healthcare infrastructure and was recognized by Guinness World Records.
2020
CMS authorizes acute hospital care at homeStrategyBackground
COVID-19 created severe hospital-capacity pressures, while the existing Medicare framework generally assumed that inpatient care occurred in a regulated hospital building with continuous on-site nursing.
Action taken
CMS created temporary waivers allowing eligible hospitals to admit and treat selected patients in their homes while maintaining specified clinical, monitoring, safety, and reporting requirements.
Aftermath
The policy accelerated United States adoption and prompted debate over whether reimbursement and regulatory authority should continue after the public health emergency.
Recent events
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