By Liz Carey for The Daily Yonder.
Broadcast version by Jonah Chester for Illinois News Connection reporting for The Daily Yonder-Public News Service Collaboration

For rural residents, just getting to the hospital during an illness can be a struggle.

A new trial of home-based hospital care may be a solution to that, officials think.

Called the Rural Home Hospital, Ariadne Labs developed the system to deliver home hospital principles to rural communities.

Mary Frances Barthel, M.D., chief quality and safety officer at Blessing Health System in Quincy, Illinois, runs the Rural Home Hospital program there. Covering a three-state area (Illinois, Missouri and Iowa), Blessing Health includes three hospitals, two physician groups, an accredited college of nursing and health sciences, and a network of medical specialty businesses. Barthel said the healthcare system provides services for about 100,000 people.

In February, Blessing Health started a three-year study of the home-based system. Based on a successful urban home hospital program at Brigham and Women's Hospital in Boston, this trial will determine whether or not it can be applied to rural settings, Barthel said.

Just three patients have entered into the randomized study so far. Two of those patients were selected to stay in the hospital. One was selected to receive at-home care.

To enter into the program, a patient has to be admitted to the emergency department and then diagnosed with something that would normally require hospitalization to treat - like heart failure, chronic obstructive pulmonary disease, asthma, gout, chronic kidney disease, or diverticulitis. Once a patient has agreed to participate, they're randomly selected to either stay in the hospital or be treated at home.

Those that are selected to be treated at home are discharged with a nurse who goes with them and sets up the necessary equipment in their house.

"They're put on a monitor that gives us their vital statistics like blood pressure, blood oxygen... that information is available to me 24 hours a day, seven days a week," Barthel said.

Patients are also connected to the doctor through telehealth visits. The nurse visits the patient in person twice a day, and Barthel checks in on them once a day via telehealth. Patients can also contact the nurse or doctor for telehealth visits if they have questions or concerns. In some cases, the monitor will connect with the doctor to alert them if things aren't right.

"If there's a change in their vital statistics, an alert will come across an app on my phone," she said.

The system also alerts her if the monitoring equipment goes offline.

"We had an incident where the patient's tablet went to sleep," she said. "I got a notification on my phone and worked the patient through making sure the device didn't turn off."

The program frees up beds for more critically ill patients and ensures the patient can access the care.

"Transportation (to the hospital) is such an issue in rural areas, especially for our elderly patients," Barthel said.

Research shows that home hospital programs tend to have higher patient satisfaction, lower readmission rates, and a reduced risk of getting hospital-acquired complications. Barthel said so far patients have reported that the program is beneficial.

"Patients reported getting up more and moving around more," she said. "We also noticed they were more compliant with their medications and that they slept better."

The program is not without its challenges, however. Barthel said some patients who were approached to join the study declined.

"They had an expectation that when they felt sick, that they were going to have people take care of them, and that they would be better when they left the hospital," she said. "We are very careful about which patients we're including. These patients did not want to go home to treat themselves."

Another issue, she said, is internet access. The hospital has developed several strategies to ensure patients have a fast enough connection for a telehealth visit, including installing a new connection.

Another obstacle is staffing. Two in-home visits a day requires a significant amount of nursing capacity.

But advocates see the program as a way to reduce healthcare disparities for rural residents.

"Access to high-value acute care services in rural communities is a growing national problem," David Levine, M.D., leader of Ariadne Lab's RHH team, said. "A randomized controlled trial will help us examine how we can provide a high quality and safe patient experience affordably in a rural context."

Blessing is one of only two American rural hospital systems to run the trial. The other, Appalachian Regional Healthcare (ARH), provides services for rural Eastern Kentucky and southern West Virginia.

Between now and the end of the study in 2025, Barthel said she hopes to sustain an average patient population of four, with new patients entering the program and ones who have recovered being released.

"Past the trial stage, we hope to be able to replicate the program with staff deployed in each of our hospitals," she said. "Our goal is to have these services available from each of our facilities."

Liz Carey wrote this article for The Daily Yonder.


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People who are part of the Deferred Action for Childhood Arrivals program, known as DACA, will be dropped from their CoveredCA health plans at the end of August.

The move comes after the Trump administration changed a Biden-era definition of "lawfully present" to revoke health care eligibility for thousands of immigrants.

Christine Smith, policy and legislative advocate for the nonprofit Health Access California, said people only have a few weeks to get medical appointments in before their coverage ends.

"If you're enrolled in Covered California and you're a DACA recipient, the Trump administration just ended your coverage," Smith emphasized. "People should use as much of your health care as you can before the August 31st deadline."

The Centers for Medicare and Medicaid Services defended the move, saying it will save taxpayers money. CoveredCA estimated the change affects about 2,400 DACA recipients in the state who make too much to qualify for Medi-Cal and have jobs not providing health insurance. They can still buy private insurance but it is much more expensive. People who prepaid for their coverage can seek a refund.

Smith predicted it will be a blow not just to those who lose coverage but to the state's health care system as a whole.

"The lines in the ERs are going to be longer because people are not going to be able to get affordable preventive care," Smith projected. "They're just going to get sicker and then end up in the ERs. People will overall incur more medical debt. Hospitals will have more uncompensated care."

The change is nationwide. As of mid-July, about 538,000 people in the DACA program across the U.S. are ineligible to enroll in any state-based insurance marketplace and are unable to access premium subsidies or cost-sharing assistance.

Artificial intelligence is appearing more prominently in many aspects of life and research suggests older populations are curious, yet remain wary of using the technology in their everyday lives.

According to Stats Indiana, there are more than 1.5 million Hoosiers aged 65 and older, or 18% of the state's population. Experts said it is likely the demographic will use AI in some form in the next few years, either by choice or necessity.

Dr. Shaun Grannis, vice president of data and analytics for the Regenstrief Institute on Aging, said AI offers real benefits.

"It can reduce loneliness through conversation, provide reminders for medications and appointments," Grannis outlined. "It can support cognitive stimulation via games, storytelling, news updates."

The technology can also offer a low-pressure way to access information on public services, he added, which is valuable for those with mobility issues or those who feel intimidated by technology.

Grannis cautioned any tool which can be used for good can also lead to problems. He noted AI can create a false sense of companionship and mask social isolation. Overdependence is a legitimate concern, he argued, if the technology becomes a "crutch" for all forms of interaction.

"All cognitive activities or decision-making, it can actually lead to and create a negative feedback loop, lead to a decline in engagement and even basic self-management skills," Grannis explained. "This is risky."

Grannis believes one solution is designing AI systems to complement, not replace, human interaction. He stressed it can be done though building broader support ecosystems including family, friends, caregivers and community services. Grannis emphasized it would encourage real-world activity, prompting the user to go for a walk, call a grandchild or attend a local senior event.

If you have an extra five minutes, you can save a life because you can learn cardiopulmonary resuscitation at no cost from a new mobile, hands-only CPR kiosk.

The new kiosk is in the lobby of Saint John's Health Center in Santa Monica. The machine's touch screen gives a brief overview of hands-only CPR and you can practice right there, on a mannequin.

Dr. Rigved Tadwalkar, cardiologist at St. John's, said it is an easy way for people to get more comfortable giving chest compressions in an emergency.

"It's a lot like a video game but of course, a lot more important than a video game," Tadwalkar pointed out. "It gives real-time feedback about the depth and rate of compressions, proper hand placement, which are all factors that influence the effectiveness of CPR."

The American Heart Association operates the St. John's mobile kiosk and a stationary model at L-A-X with support from the hospital. Santiago Canyon College in Orange County also has a mobile hands-only C-P-R kiosk now through September, sponsored by Edwards Lifesciences.

Steven Munatones, an Orange County business owner, said he survived what's known as a "widowmaker" heart attack which led to cardiac arrest nine years ago, thanks to his 17-year-old son, who gave him immediate CPR with instructions from a 911 operator.

"You don't have to put your mouth to anybody's mouth," Munatones explained. "You just put your hand on their chest and pump. He saved me, and others can do the same, anywhere. So, it's absolutely a lifesaving, heroic act that anybody can do."

Statistics show 350,000 Americans suffer from cardiac arrest outside a hospital each year and about 90% die, in part because they do not receive CPR. About 70% of those cardiac arrests happen at home, so people often depend on family or friends to give CPR before an ambulance arrives.