Hospital-level care, right at home
Parkland program combines technology with a personal touch
When David Ratliff returned home following the partial amputation of a toe, he did not leave Parkland Health behind.
In many ways, the hospital came home with him.
Ratliff had developed an infection in the bone of the middle toe on his right foot and needed continued intravenous antibiotics following surgery. Instead of remaining hospitalized to receive that treatment, he qualified for Parkland’s Hospital at Home program, which provides hospital-level care to eligible patients in the comfort of their own homes.
“I wasn’t quite sure what to expect when they first told me I could go home and still be a hospital patient,” Ratliff said. “But once they explained how it would work, going home sounded pretty good. I could sleep in my own bed, be with my family and still have the Parkland team taking care of me.”
Before Ratliff left Parkland, the Hospital at Home team prepared him and his wife, April Foran, for what would come next. They received detailed information and contact numbers, medications and equipment that would connect their Carrollton home to Parkland around the clock.
The equipment included a pulse oximeter, portable blood pressure cuff, remote monitoring device and a digital tablet that allowed Ratliff to communicate virtually with nurses and physicians.
But technology was only part of the care.
Every day, Ratliff met virtually with a physician or advanced practice provider. Nurses arrived at the home twice a day to check his vital signs, administer medications, change the dressing on his surgical wound and make sure he had the supplies he needed.
Hospital at Home can also provide patients with laboratory testing, infusion therapy, physical and occupational therapy, medication management, transportation, nutrition support, social work and care coordination, depending on their individual needs.
For Parkland, having providers visit patients in their homes is an important part of the Hospital at Home model.
While virtual care offers convenience and allows the team to remain closely connected to patients, an in-person visit can provide valuable insight into a patient’s home environment and other factors that may affect recovery. Kassidy James, Lead Advance Practice Provider with Hospital at Home, visited Ratliff during his time in the program.
“There is so much we can learn when we step into a patient’s home that we may never see during a virtual visit,” said James. “We can better understand the environment where they are recovering, identify potential barriers to their care and spend time with them where they are most comfortable. It takes additional time for our providers, but we believe that personal connection is an important part of providing truly patient-centered care.”
“What impressed us most was the caliber of the nurses who walked through our door,” said Foran, who is Parkland’s Director of Corporate Communications. “Every single one was professional, knowledgeable and compassionate. They were not simply coming into our house to give David an IV. They took care of him, talked with us, answered questions and made us feel that we were still connected to Parkland.”
Even the family’s dogs became part of the routine. Kept safely behind a gate in the kitchen during nursing visits, they watched closely as the nurses cared for their “dad.”
For Hospital at Home Senior Registered Nurse Kemunto Kenani, caring for patients in their own environment offers something that can be difficult to replicate inside a hospital.
“Patients tend to be more comfortable at home. They rest better, and that peace of mind can help with their healing,” said Kenani, who joined the Hospital at Home team in 2023 after years in acute care. “The best part is not being confined to the four walls of a hospital. My sunshine can bring sunshine to my patients.”
Senior Registered Nurse Sherlyn Joy Cowdrey, one of the program’s newer team members when she began caring for Ratliff, said Hospital at Home gives nurses an opportunity to form relationships with patients and their families.
Early in her nursing career, Cowdrey watched a resident shake a patient’s hand at the end of a visit. It was a simple gesture, but one that stayed with her. From that day forward, she decided she would make a point of shaking hands with her patients, a reminder that before there is a diagnosis, a treatment plan or a hospital room, there is a person.
“First and foremost, they are human beings. Human first, patient second,” she said. “When I first meet a patient, I shake their hand because I want to make that connection. With Hospital at Home, you have time to get to know your patients and their families and provide education. You are not just treating an illness. You are caring for a person.”
Parkland transferred its first patient to Hospital at Home in April 2022 after receiving approval from the Centers for Medicare & Medicaid Services (CMS) and the Texas Health and Human Services Commission. Since then, the program has steadily expanded both the number and complexity of patients it can care for at home.
As of Aug. 17, 2026, Parkland’s Hospital at Home program had cared for 1,660 patients and created 11,637 hospital bed days. During fiscal year 2026, patients spent an average of 7.5 days in Hospital at Home. A February 2026 evaluation also found that a Hospital at Home episode cost approximately 30% less than care delivered in a traditional hospital setting.
The program serves patients with an increasingly broad range of medical needs. Infectious diseases account for the largest share of patients, including urinary tract infections, diabetic foot infections, cellulitis, bacteremia and other conditions that may require IV antibiotics.
Hospital at Home also cares for patients with renal, cardiac and other conditions and has expanded its capabilities to include wound vacs, continuous telemetry, oxygen therapy, point-of-care laboratory testing and other hospital-level services in the home.
“Hospital at Home allows us to bring the clinical capabilities of the hospital to patients in an environment where many of them are more comfortable, while maintaining the connection to their Parkland care team,” said Stephen Harder, MD, Lead Physician and Medical Director of Parkland’s Hospital at Home program. “The goal is not simply to get someone out of the hospital sooner. It is to provide the right level of care in the right setting. And if a patient’s condition changes and the hospital becomes the safest place for that care, we can recognize that change and quickly transition them back.”
For Ratliff, that ability became critically important.
He had been receiving Hospital at Home care for nearly two weeks and was doing extremely well.
Then something changed.
“It was almost like someone flipped a switch,” Foran said. “David began coughing and having difficulty breathing. He was declining very quickly, and I knew something was not right.”
Foran contacted Dr. Harder. After initially watching Ratliff’s symptoms to see whether they improved, she called again an hour later.
“I said, ‘We need to go to the hospital.’ From that moment, the Hospital at Home team paved the way for us,” she said. “By the time we arrived at the Emergency Department, the team was ready for him.”
Following X-rays, blood tests and an evaluation by Parkland’s Rapid Assessment Team, Ratliff was diagnosed with pneumonia and admitted to the intensive care unit. His care team determined that the pneumonia was caused by a rare reaction to the high-dose antibiotic he had been receiving to treat the infection in his foot.
The experience underscored another benefit of Hospital at Home: when David needed a higher level of care, his connection to Parkland had never been broken.
“I think that is when we fully understood what ‘Hospital at Home’ really means,” Foran said. “We were not on our own at home. David was still a Parkland patient, and when he suddenly needed to be back inside the hospital, the people who had been caring for him were right there.”
That relationship continued even after Ratliff was admitted to the hospital.
Members of the Hospital at Home team, including Dr. Harder, stopped by his hospital room to check on him. The team even brought get-well balloons to lift his spirits.
By the time Ratliff was well enough to leave Parkland again, he no longer required Hospital at Home services.
That was good news, although it came with an unexpected downside.
“I was certainly glad I didn’t need that level of care anymore,” Ratliff said. “But after seeing those nurses twice a day, you get used to having them around. They were not strangers coming into our house. They became people we looked forward to seeing.”
Foran agreed.
“When it was over, we were incredibly grateful David was doing well, but there was also this strange feeling that we were going to miss them,” she said. “There really are no words to adequately express our gratitude for the care and compassion they gave David. Hospital at Home brought Parkland into our home when we needed it, and when we needed the hospital again, they got us safely back there.”
For Ratliff, the experience changed his understanding of what it means to be hospitalized.
“I always thought being in the hospital meant being in a hospital bed,” he said. “Now I know it can also mean being in your own bed, with your family nearby, while an entire healthcare team is still looking after you.”
For more information on Parkland’s Hospital at Home program, please visit www.parklandhealth.org/hospital-at-home.
For information about services available at Parkland, visit www.parklandhealth.org.
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