By Michelle Crouch
When 6-year-old Mackenzie Conlon was hospitalized with the flu at Atrium Health Levine Children’s Hospital in February, all she wanted was to go home, her mother, Stephanie Conlon, said.
Mackenzie, who has complex medical needs due to cerebral palsy, had been fighting high fevers, dehydration and pain so intense her constant crying left her nearly voiceless. Conlon, 46, said she would watch helplessly when her daughter pointed at the hospital door in a plea to leave.
But after five days of round-the-clock hospital treatment, Atrium’s providers offered the family an unexpected alternative: continue Mackenzie’s hospital care at her Charlotte home.
Thanks to Atrium’s new pediatric hospital-at-home program, Mackenzie could recover in her own bed, with access to her favorite TV shows, foods and toys, while still receiving hospital-level care.
The family jumped at the chance.
“As a parent, watching your kid be in a hospital is just the most heartbreaking thing,” Conlon said. “So finding out that we were able to go home just completely switched the mood. … This is where all of her favorite things are. For me as a parent, knowing I could sleep in my own bed, knowing I could take a shower, those little comforts made all the difference.”
More comfort for patients, less hospital crowding
Atrium’s is the first hospital-at-home initiative in the nation designed specifically for children, the hospital system said. Modeled after similar programs for adults, it combines home visits from paramedics, remote monitoring and virtual check-ins from doctors and nurses to deliver hospital-like care while patients heal at home.
Hospital-at-home programs have taken off in recent years, spurred by the loosening of hospital regulations during the COVID-19 pandemic. (The programs operate under a special waiver that has been extended multiple times and is now scheduled to expire on Sept. 30.)
Today, 142 health systems in 39 states have federal approval to provide home hospital care, including seven in North Carolina: Novant Health, Duke Health, UNC Health, WakeMed, Cone Health and Scotland Memorial Hospital, in addition to Atrium.
For patients, the appeal is obvious. You get to recover in the comfort of your own home without constant interruptions, omnipresent fluorescent lights and beeping machines, or the risk of hospital-acquired infections. That’s especially important for kids, who may not understand why they’re in the hospital and may feel more anxious in an unfamiliar environment.
For hospitals that are struggling with capacity, it gives them a way to open up more beds for the sickest patients.
Early research on the adult programs has been promising. A 2024 report to Congress found that most patients were happy with the care they received and that their health outcomes were better than those of similar patients treated in the hospital.
The researchers cautioned that the data was limited and may be skewed by statistical bias. They found that the patients in these programs tended to live in urban areas, tended not to be low-income or on Medicaid, and were more likely to be white. More than a third of hospital-at-home patients nationally had respiratory problems, like Mackenzie.
They also noted that the patients who were able to be sent home tended to be “less clinically complex overall.”
In a separate study last year, Harvard Medical School researchers analyzed the cases of more than 5,000 Medicare patients who received hospital home care in 2022 and 2023 and found low rates of mortality and hospital readmissions within 30 days.
Concerns about safety and cost
Critics say that shifting hospital care into the home, especially for kids, is a risky move.
They argue that family members aren’t equipped to handle emergencies, technology can fail or miss subtle signs of a patient’s decline, and that if something goes wrong, help might not arrive fast enough. (The federal government requires patients to be close enough that the hospital can respond to a change in their condition within 30 minutes.)
“In the hospital, we’re right there with the tools to save a child’s life,” said Michelle Mahon, director of nursing practice at National Nurses United, a California-based nurses group that opposes the programs. “At home, it could take 30 minutes for an ambulance to arrive — and that’s too late. It’s alarming that vulnerable infants and children would be placed in this type of precarious program.”
Mahon added that hospitals have a financial incentive to create the programs because they can charge the same rates as if the care was happening inside a hospital — including facility fees — even though they don’t face the usual overhead costs.
A spokesperson for the North Carolina Nurses Association said it isn’t affiliated with National Nurses United and that its board of directors hadn’t discussed the hospital-at-home model specifically or taken a position on it.
Some say more research is needed
Eileen Appelbaum, an economist and co-director of The Center for Economic and Policy Research, agrees there are risks — but she said it comes down to how the programs are designed and run.
“If the decisions are made carefully, if patients are selected carefully, if the parent is able to provide the support the patient needs, and if the family is computer-savvy so they can deal with telehealth connections, then I do think it can be positive,” said Appelbaum, who co-authored a 2023 report analyzing the model.
She’s concerned, though, about some of the choices hospitals are making, such as relying on paramedics instead of nurses for at-home visits. Paramedics are less expensive than nurses, Appelbaum said, but they have less training.
Appelbaum said more peer-reviewed research is needed to assess the quality and costs of the programs compared to hospital-based care and to set standards for which patients should receive treatment at home and how that care should be billed and administered.
In a statement, an Atrium Health spokeswoman said patient safety is its top priority.
“We carefully evaluate patients for hospital at home, including caregiver support availability and willingness, much like we do when we evaluate patients for full discharge,” the statement said. “The informal feedback we receive from our families is that this decreases burden on them because being home is easier.”
The paramedics who make the home visits receive additional training, the hospital said, including tips from child life specialists about how to make children comfortable during difficult procedures.
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Goal: 10% of patients treated at home
Atrium’s adult hospital-at-home program, one of the largest in the country, serves about 90 adults a day. Hospital leaders started talking about offering a similar program to children about a year ago, said pediatrician Stefanie Reed, the program’s medical director.
“We were looking at ways to help make sure that children were able to receive great care with us despite our growing capacity constraints and the growing nature of our city,” she said, noting that some pediatric patients face long delays waiting for beds. “This is the right thing for our patients, and it’s the right thing to help our capacity and growth.”
As of mid-April, about 40 children and adolescents had been admitted to the program, she said, and the feedback has been overwhelmingly positive. Eventually, she said, Atrium hopes to expand the program to its other hospitals, with a goal of treating 10 percent of its pediatric patients at home.
To ensure safety, the hospital has specific criteria about which types of patients are eligible, Reed explained. Some are admitted directly from the emergency room. Others, like Mackenzie, transition after having had some inpatient care.
Families always have the choice to stay in the hospital, Reed said.
One recent patient was a teenager with pneumonia who couldn’t wait to get back to her video games, see her dog and finally have a little space from her parents, she said.
The teenager “had a type of pneumonia that required closer monitoring and IV therapies — not something she could do outside hospital care,” Reed said. Without the program, she probably would have had to spend another week in the hospital, Reed said.
A new kind of house call
After Mackenzie’s family made the decision to shift to home care, paramedics set up the necessary equipment and visited twice a day, connecting to Mackenzie’s doctors by video while performing a physical exam.
Billy Long, 32, the community paramedic who usually visited Mackenzie, used a digital device that allowed the doctor to listen to Mackenzie’s heart and lung sounds and to look into her ear canal and throat.
While he administered IV fluids, Long kept Mackenzie entertained with games and stickers.
A longtime ambulance paramedic, Long worked part time in an Atrium Health pediatric emergency room before switching to home hospital care. He said his new role is less stressful, and he especially likes working with kids.
“It’s just fun,” he said. “My last patient I saw was just happy as a clam, sitting in grandma’s lap while I was on the tablet with Dr. Reed. Then the other day, I had a 30-month-old pulling me around by my finger, showing me every single toy he owned.”
As home hospital programs expand, the demand for paramedics like Long — particularly ones with lots of experience — is increasing, creating more competition for a limited pool of workers.
More cozy and comfortable
Conlon said being at home, where she and McKenzie could eat their normal foods, go for walks outside and sleep in their own beds, made them both more comfortable.
“I could just curl up in bed with her or do a breathing treatment for her with just the night light and sound machine on — things that are very cozy to her,” she said.
It was also reassuring, she said, that her daughter’s health care team was just a click away.
“There were so many times where I was texting the nurse at four in the morning,” she said. “I always got responses immediately.”
Mackenzie was enrolled in the program for three days before she was discharged.
Conlon said knowing home-based care is available will make it easier the next time she has to take Mackenzie to the hospital.
“It really changes your perception because if you do need to go to the ER, you know you have the potential to be home sooner,” she said. “I would do this again in a heartbeat.”
This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting.
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