Hospital-at-home (HaH) seeks to deliver hospital-level services in the home setting for patients with acute illness. For more than 30 years, these programs have been found to be safe and cost-effective for adults, with outcomes comparable to traditional hospital care. HaH care models have evolved over time and typically include home delivery of equipment and supplies, daily nursing visits, virtual or in-person clinician visits, and an emergency response system. [JAMA]
Growth of HaH accelerated in 2021, after the Centers for Medicare & Medicaid Services (CMS) established the Acute Hospital Care at Home (ACHAH) waiver program. The initial intention was to expand hospital capacity during the COVID-19 pandemic. Since then, more than 400 hospitals across 39 states have received waivers for adult HaH reimbursement. Although the waiver expired in September 2025 alongside the US government shutdown, many hospital leaders anticipate that HaH programs will continue with a new waiver or longer-term reimbursement policy.1
Pediatric HaH has not kept pace with nearly 30 years of progress for adults, but recent policy and technological advances have opened a new window of opportunity. Over the past 5 years, several pediatric HaH programs implemented in Europe have been found to be safe and highly desired by caregivers.2,3 In early 2025, Atrium Health launched the first US-based pediatric HaH program. Continued growth of pediatric HaH in the US will require a more robust research and policy infrastructure. This Viewpoint describes barriers to pediatric HaH implementation, current opportunities for pediatric HaH programs, and policy changes needed to support their growth.
Barriers to Implementation of Pediatric Hospital-at-Home
Several factors have delayed implementation of pediatric HaH. First, children represent a small fraction of total medical expenditures and have therefore not been a major target of cost- or capacity-focused innovations.4
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