National Nurses United condemns industry plans to maximize profit by sending patients home all alone, replacing 24/7 hands-on nursing care with technology
Kaiser’s program example of massive industry drive to eliminate hospitals and nurses, endangering patients by depriving them of real nursing care
Registered nurses have a legal and moral obligation to always advocate for the best interests of our patients. That is why we are completely opposed to Kaiser Permanente’s current and long-term plans to maximize revenue by dramatically limiting opportunities for nurses to care for patients in a hospital setting, and instead sending patients home to be remotely monitored by technology.
In a program that Kaiser calls “Advanced care at home,” Kaiser diverts patients who would normally be admitted into its hospitals back to their homes. Doctors and other staff identify and approach candidates to voluntarily enroll (for now) in the program. In their residences, the patients would be mainly monitored through an iPad and cameras connected to a medical “command center” potentially located hundreds of miles away. To implement the program, Kaiser has partnered with the Mayo Clinic to invest $100 million in a Boston-based startup called “Medically Home” to provide the supplies and occasional staff who visit the patient. The program is currently operating at two pilot sites in California, Vacaville and Vallejo, but Kaiser has plans to roll out the program system-wide.
These types of programs are not limited to Kaiser but part of an industry trend that Kaiser seeks to be at the forefront in normalizing; at least 82 health care systems encompassing 186 hospitals in 33 states currently have permission from the federal government to operate and bill Medicare for these arrangements.
Nurses are horrified by Kaiser’s attempts to redefine what constitutes a hospital and what counts as nursing care. Not only does this program endanger the imminent safety and lives of patients, it completely undermines the central role registered nurses play in the hands-on care that patients need to safely heal and recover. The entire reason for being admitted into a hospital is to benefit from the 24/7 monitoring, assessment, and professional care that licensed registered nurses provide. Nurses, more than any other health care staff, spend the most time with patients. We reject Kaiser’s assertion that iPads, cameras, monitors, and the occasional visit by likely lesser-skilled and unlicensed personnel are in any way comparable to the skilled, expert nursing care and social emotional support we RNs provide every moment of every shift.
Without 24/7 RN staffing, family members will likely need to step in, creating stress and leaving patients attended to by laypeople. We are also acutely aware that what these programs will ultimately do is shift unpaid care work onto women inside the home, while taking away paid care work from a predominantly female RN workforce at the hospital.
Furthermore, patients in a hospital setting benefit from being physically close to many other specialized departments, units, and equipment. Transfers and emergency tests and labs often happen within the same building. Nurses know that our patients can be fragile and their condition can deteriorate quickly and unexpectedly. We are appalled by the idea that our patients could be stranded at home in case of an emergency or adverse event, with no way to get immediate help or medical intervention and treatment.
Kaiser and the hospital industry will claim that these programs which purport to provide hospital care in patients’ homes have as-good-as-or-better outcomes than patients cared for in a regular hospital setting, but we are skeptical of these small, selective, limited studies and suspect that these rosy outcomes are largely the result of cherry-picking the healthiest patients with the least complications, and that such outcomes could not be maintained once these programs are scaled up to include high-acuity, complex cases.
In its own materials, Kaiser acknowledges that the driving force behind this program to send people home and keep them out of the hospital is to dramatically cut the costs of maintaining and operating traditional hospitals and staffing hospital beds with registered nurses. The core motivation has never been to improve patient care. Kaiser, as well as other hospital systems across the country experimenting with these models, believes it has seized onto the revelatory idea that it can shift these overhead costs onto the patient by sending them home. This model will prove to be a gold mine for Kaiser and the rest of the hospital industry, as long as payers such as the Centers for Medicare and Medicaid Services reimburse them at the same rates that traditional hospital care commands. These reimbursements are allowed under current Covid-19 waivers for telemedicine, but the hospital industry is lobbying desperately to make these arrangements permanent to ensure this new model continues to provide lucrative revenue.
In the long term, what this means is hospitals as we know them are likely to disappear. The industry thinks that’s not only a good thing, but is on a mission to convince the public of the same. Already, the industry is promoting home as a safer place to avoid hospital-acquired infections and other dangers, but it already has the power to mitigate such risks now. Actually, burdening inexperienced patients or their family members with self-providing care at home has been shown to cause infections.
And as more and more patients are sent home, hospitals will use the lower patient census as justification to close inpatient beds and further cut RN staffing, leading to a self-fueling death spiral of your community hospital. Brick-and-mortar rural hospitals, already an endangered species, will certainly go extinct.
The industry will accuse registered nurses of opposing this and similar programs because we simply want to “keep our jobs.” That’s exactly right. Hospital nurses do want to keep our jobs because we know our profession serves a critical role in our society: We are highly educated, knowledgeable, and skilled professionals who care for the sickest of the sick with our healing touch. We practice the art and science of nursing and all patients must have equal access to our care.
Additionally, registered nurses are concerned that these types of programs will exacerbate racial disparities in who receives hospital care and who is sent home, and among those sent home, who fares better and who fares worse. If hospitals incentivize the option of being sent home with lower prices, it will likely be patients living in already medically underserved communities -- who are often Black, Indigenous, Brown, and other patients of color -- pressured to make that choice. Among those sent home, those with better housing, resources, and family and social networks will do better than those without.
For all these reasons and more, registered nurses are demanding that the hospital industry, the public, and private and government payers such as the Centers for Medicare and Medicaid Services abandon these plans to send home patients who should be admitted to hospitals. Patients must not be left home all alone. We nurses will escalate our advocacy for a single standard of direct, quality care for all patients. As a country, we need to invest in the proven health care infrastructure and RN workforce we know we need -- and that our current Covid pandemic painfully reconfirms we must have -- to care for the nation’s patients.
The California Nurses Association represents more than 100,000 registered nurses and is a founding member of National Nurses United, the largest and fastest-growing union and professional association of registered nurses in the United States with more than 175,000 members nationwide.