Lawmakers, providers push to codify Hospital-to-Home liaisons after pilot shows cost, discharge benefits
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Summary
Supporters urged the Joint Committee on Aging and Independence to make the Hospital-to-Home Partnership permanent (H.780 / S.495), saying bedside liaisons embedded in hospitals reduced readmissions, connected older patients to home services and saved money during a two‑year pilot funded by EOHHS.
Sen. Pat Jelen and Rep. Liber Garabedian's committee heard testimony urging a favorable report on H.780 (S.495), a bill to establish the Hospital‑to‑Home Partnership statewide and preserve hospital‑embedded liaisons that coordinate discharges to home and community‑based services.
Backers told the committee the program was piloted with Executive Office of Health and Human Services (EOHHS) funds in 2023 and created dedicated ASAP (Aging Services Access Point) staff embedded in hospitals to coordinate discharges, enroll new clients in home services and prevent unnecessary nursing‑home placements. Mystic Valley Elder Services said the pilot created 16 partnerships across the Commonwealth and served at least 700 patients, enrolling 103 people who were previously unaffiliated with ASAP services.
Mystic Valley CEO Lisa Gorgone and her hospital‑to‑home team described bedside warm transfers, immediate post‑discharge follow‑up and examples of avoided hospital or institutional stays. Gorgone cited a December 2024 case in which a 70‑year‑old woman hospitalized with pneumonia because she lacked heat later received oil delivery, laundry and ongoing care management; Mystic Valley estimated her monthly community costs at about $878 versus roughly $36,000 for the hospital and short‑term nursing stays combined. Katie Sweet, Mystic Valley’s program manager, described a March 2024 case of an unhoused 61‑year‑old who, after discharge, was helped into housing and benefits and connected to ongoing supports.
Betsy Crimmins, executive director of Mass Aging Access (the nonprofit association for the 27 ASAPs), said the initiative began with $3 million in ARPA grants over two years and argued codifying it into statute would protect partnerships facing funding lapses and produce net savings by reducing “stuck” patients in acute care. Testimony from Somerville Cambridge Elder Services and other ASAPs described hundreds of successful transitions and urged making the program permanent.
Committee members asked about statewide data and cost estimates; witnesses said statewide collection is underway and that the Healthcare Policy Commission and EOHHS have been engaged. Witnesses acknowledged some partnerships already reduced liaisons’ schedules because of funding gaps and asked the legislature to secure ongoing funding.
Supporters emphasized the program’s role as a nursing‑home diversion, its alignment with hospitals’ interest in reducing uncompensated care, and the relatively small cost compared with hospital and nursing home expenditures. The committee did not take a vote during the hearing; advocates asked for a favorable report.