Hospital at Home (HaH) Works, but Indian Country Needs a New Model

Home-based care dramatically reduces mortality rates, yet zero IHS or Tribal hospitals participate in the federal program.

Federal Data Proves Hospital at Home Saves Lives

A 2026 study in JAMA Network Open tracked nearly 16,000 fee-for-service Medicare beneficiaries in hospital-at-home (HaH) programs. Mortality was just 0.4%, compared to 3.6% for traditional inpatient stays. ED readmission rates fell to 8.8% over 30 days, versus 10% for in-person hospitalizations. Over 80% of participants reported positive experiences. In February 2026, Congress authorized a five-year HaH extension.

Yet of 68 hospitals studied, just 11 accounted for half of all admissions — all urban, none serving Native populations. CMS requirements, including 24/7 remote monitoring, reliable broadband, and sub-30-minute emergency response times, remain infeasible across vast Tribal lands where elders may live hours from the nearest IHS facility.

Traditional Models Cannot Solve This Problem Alone

Programs like Arizona’s American Indian Medical Home and Community Health Representatives deliver critical home-based services through IHS and Tribal 638 facilities at Chinle, Phoenix Indian Medical Center, and Tuba City. These whole-person models integrate traditional healers, family care structures, and Our Relatives’ cultural practices into outpatient management.

However, persistent vacancies in clinician staffing across Indian Country still prevent dedicated mobile home-care teams from forming. The CMS Tribal Technical Advisory Group has urged federal regulatory relief, but structural barriers remain.

Ellsworth and Hoyani Bypass the Bottleneck

As an ISBEE-certified, Native owned small business, Ellsworth provides temporary clinical staffing to the Indian Health Service through ISBEE set-aside contracts. Our credentialed clinicians serve IHS facilities today, and we are actively expanding relationships with Tribal 638 medical centers. Closing the hospital-at-home gap in Indian Country will require new workforce models — decentralized, on-demand clinician networks that deploy to Native homes rather than pulling staff from already under-resourced hospitals.

Ellsworth is also developing Hoyani, a proof-of-concept platform designed to unify home visit scheduling, telehealth, and multi-payer billing across IHS, VA, and Medicaid systems. Hoyani is early-stage, but the vision is clear: culturally competent care dispatched directly to Indigenous families and elders.

Better Native Health Starts With Showing Up

The data is undeniable. Home-based care saves lives. Indian Country deserves access to it. Ellsworth is committed to staffing the clinicians and building the tools that bring cultural awareness and clinical excellence to where Our Relatives live.