Domiciliary Hospitalization: Hospital-Level Care at Home

Domiciliary hospitalization (also called hospital-at-home or home-based acute care) delivers hospital-level medical services in a patient's residence instead of a traditional inpatient facility. It is designed for acute conditions that would otherwise require hospitalization but can be safely managed at home with appropriate clinical support.

Core Components

• Clinical Team: Physicians (often hospitalists), registered nurses, nurse practitioners, paramedics, and allied health professionals.
• Services Delivered:
  • IV medications (antibiotics, diuretics, steroids)
  • Point-of-care labs (blood gases, electrolytes, coagulation)
  • Portable imaging (chest X-ray, ultrasound)
  • Oxygen therapy and respiratory monitoring
  • Wound care, catheter management, central line care
  • Vital sign monitoring (continuous or intermittent telemetry)
• Technology: Remote patient monitoring (RPM) devices, video visits, electronic health record integration.
• Availability: 24/7 clinical support with defined escalation protocols.

Eligibility Criteria (Typical)

• Acute condition with established diagnosis (e.g., pneumonia, COPD exacerbation, CHF, cellulitis, DVT, pyelonephritis).
• Clinically stable enough for home management (no ICU-level needs).
• Safe home environment with caregiver support (or ability to self-manage with assistance).
• Geographic proximity to the hub hospital (usually ≤ 15–30 miles).
• Patient/caregiver consent and understanding of the model.

Benefits

• Reduced hospital-acquired infections, delirium, and functional decline.
• Lower cost per episode vs. traditional inpatient care (studies show 19–30% savings).
• Higher patient satisfaction and preference.
• Frees inpatient beds for higher-acuity patients.

Models in the US

CMS Acute Hospital Care at Home waiver (COVID-19 PHE origin, extended), VA Hospital at Home, and private payer/integrated delivery system programs (e.g., Mass General Brigham, Johns Hopkins, Mount Sinai).