Commentary by Sheryl Markowitz, MSW, LCSW, LISW-S
Co-Founder, Principal Advisor, Health Transformation Advisory

A patient with pneumonia is admitted to Hospital at Home. The first member of her care team to see her house arrives after she’s already home. The decision about whether that house could safely hold an acute admission was made in a hospital, from what she could report from a gurney.

Medicare’s Hospital at Home waiver specifies the clinical requirements to the minute. On the home itself, it requires one sentence: “appropriate screening protocols.” No named owner, no instrument, no documentation standard. What fills that gap is an environmental and psychosocial assessment that quietly decides who gets access to inpatient care at home, and nobody is recording the results.

Congress just extended the program through 2030 and asked for a report on who’s being served, including income and housing data. The evidence for that report is being generated right now, one unrecorded screening at a time.

The full piece is below, including what a standard would require and why none of it needs new legislation.

Download the full piece:

The Assessment Nobody Owns