As COVID-19 surges across Israel again, the country should encourage sick people who do not have the virus to take advantage of home health care to help protect the hospitals from collapsing, keep the country out of lockdown and the economy open.
“We need a new paradigm in the way we provide care,” said Dr. Itamar Ofer, president and chairman of Sabar Health Home Hospital. “Home health care is a must for Israel.”
Prime Minister Naftali Bennett has said that he will shift the country’s COVID policy to one that focuses not on total coronavirus cases or serious patients but on whether or not the hospitals can manage their caseload, according to a report by N12’s Dana Weiss that The Jerusalem Post has confirmed.
In accordance with this policy, the government roll out a short, effective and efficient lockdown only when the hospitals are on the verge of collapse.
The third shots of the Pfizer vaccines that Israel began administering to people over the age of 60 last week should reduce the number of serious cases the country sees. If combined with efforts to promote home hospitalization, perhaps Israel’s hospitals will never get to a breaking point.
“Before the outbreak of the current pandemic, hospital occupancy rates in Israel were already the highest in the developed world, while its mortality rates from infectious diseases – which doubled in the past two decades alone – were not only higher than in every other developed country: They were 73% higher than the second-ranked country,” according to Prof. Dan Ben-David, president and founder of the Shoresh Institution for Socioeconomic Research and a faculty member at Tel Aviv University’s Department of Public Policy.
DURING EACH of the three previous coronavirus waves, Israel shut down in order to ensure that the hospitals did not become so overloaded that patient care suffered and individuals were left to die – such as what happened to Moshe Harazy, a 47-year-old father of five in January.
He was being treated for COVID-19 at Tel Aviv Sourasky Medical Center when his ventilator’s breathing tube detached, and staff could not get to him in time. A statement from the hospital said that the team was “facing multiple simultaneous alerts in the intensive care unit” and that “staff were busy responding to other patients’ emergency alerts and were only able to evacuate them after several minutes.”
Hospitals had been overcrowded during that period with around 2,000 coronavirus patients, including more than 1,000 in serious condition. Patients in serious condition, especially those who are intubated, need to be treated in intensive care units.
However, as Ofer explained to the Post, about 20% of people who receive care in one of the country’s 4,500 internal medicine hospital beds could be treated at home. That’s around 900 patients.
In reality, only an average of 100 of these patients are taking advantage of the country’s home health care system, despite it being covered by the health funds and saving money.
“The most expensive way to treat people is at the hospital,” according to Ofer, who is also co-chairman of the World Hospital at Home Congress. “When there is an alternative, you must try to use the alternative.”
Hospitalization at home costs about a third less than hospital admission. And the indirect savings is even more because it also saves on hospital readmissions. Around 20% of all people who are released from the hospital are readmitted within 30 days, he said. Home hospitalization cuts that number in half to around 10% in Israel.
It also reduces the chances of the elderly, who are often immunosuppressed, contracting infections unrelated to the disease for which they are being treated in the hospital – and provides them the comfort of being treated in a familiar environment.
Home hospital care means that a team of medical professionals takes clinical responsibility for the patient in his or her home and are available 24/7 for emergencies. Otherwise, there is one visit per day each by a doctor, nurse and paramedical professional.
CHAIM FREUND, 50, from Jerusalem was recently admitted to a local hospital due to cellulitis. When he was released from the emergency department, his doctor gave him the choice of being transferred to the hospital’s internal medicine ward or receiving care through Sabar Health Home Hospital. He decided to give Sabar a try.
“I got a call from the doctor, and he came to see me the night that I was released,” Freund told the Post. “He administered my antibiotics and on Friday a nurse came and then again in the afternoon and then in the evening.”
Each day, a professional came to check his vital signs and do his blood work, he said. The team brought a box of all the supplies they needed to his home on the first day and each time a staff member would arrive he or she would use what was needed or replenish what was missing. The same doctor stuck with him until he recovered.
“It is definitely more comfortable to be at home – and I felt like I got the same care as I would have gotten in the hospital,” Freund said. “This is the message that people have to know: There is an alternative. A hospital is a place of germs and it’s not really a place you want to be. This was almost like they set up a mini hospital in my home, catering specifically to my needs.”
Investing in strengthening the home hospitalization system and promoting it among the right patients now could also set up Israel for success in the future.
Israel is aging. Every year, the country has about another 24,000 people over the age of 75 – and is expected to end the decade with 70% more people in the over-75 age bracket than at the beginning. Elderly people tend to get sicker and need more medical services.
For this population, “home healthcare could be a game changer,” Ofer said.
The COVID-19 crisis is not over. Israel needs to look for the right ingredients to enable the public to live alongside the pandemic. Home hospitals should be part of that recipe.