While assisted living homes care for the chronically ill, they don’t do it for the acutely ill. If a resident needs acute care, they go to a hospital. When they do, people over 80 are at elevated risk of death. If they don’t go, then they just decline in place.

In response to the Pandemic and a pressing need to isolate at home, Medicare and Medicaid launched the “Acute Hospital Care At Home” program. It enabled hospitals to care for patients wherever they were, reduced costs and improved patients’ experience. At the end of 2022 there numerous participating entities including 114 health systems and 253 hospitals participating.

Medicare regulations require a comprehensive assessment to start services and again every 60 days with detailed documentation. The range of Medicare acute medical services includes for example; changing and monitoring medication plans, wound care, weight loss or fever, loss of functional abilities, and rehabilitation.

The models vary but provide patients with daily nursing visits and medical oversight. Medical help is on call 24/7. Typical programs combine in-person and video visits, with telehealth monitoring, and include delivery of oxygen, intravenous fluids, antibiotics, etc.

Unlike assisted living home or insured long-term custodial care services, these are Medicare approved and usually covered. Medicare requires patients be "homebound" but it need not be permanent and is flexibly applied. Medicare also requires a patient’s choices include any local Medicare approved agency, expanding a patient’s options regardless of where they live.