Mass General Brigham (MGB) has launched two clinical trials to test whether acute, hospital-level care can be safely delivered inside a patient’s home for two groups that have traditionally been excluded from such models: people living with dementia and those experiencing acute psychiatric episodes.

While Hospital-at-Home programmes have become fairly standard across health systems for conditions like heart failure, COPD and pneumonia, patients with cognitive impairment or acute mental health crises have almost always been treated in traditional hospital settings. MGB’s new trials aim to change that.

Testing a Home-Based Model for Dementia Care

The first trial, funded by the National Institute on Aging (NIA), is a randomised controlled study following 200 patients over 12 months. Patients with moderate-to-severe dementia are being randomly assigned to either standard inpatient hospital care or a proactive Home Hospital model. The home-based approach combines scheduled in-home care planning, on-demand virtual urgent care, and mobile integrated health paramedics who can respond directly during acute episodes — with the goal of determining whether this setup can safely prevent traumatic emergency department visits and unnecessary hospital admissions.

A First-of-Its-Kind Psychiatric Home Hospital Pathway

The second trial, backed by the Thompson Family Foundation, is being described as the nation’s first clinical study to test an emergency-department-to-home hospital pathway for primary psychiatric conditions — including acute psychosis, major depressive episodes, severe anxiety, and behavioural symptoms linked to dementia. This 20-patient feasibility pilot relies on specialised mobile clinical teams made up of psychiatrists, psychiatric nurses, clinical psychologists and licensed mental health specialists who manage both medical and behavioural stabilisation directly at the patient’s residence.

Why Traditional Hospital Settings Can Be Harder on These Patients

Researchers note that the sensory disruption, rigid routines and ambient noise typical of hospital units often worsen behavioural symptoms and can trigger hospital-acquired delirium in dementia patients. At the same time, emergency departments continue to face persistent boarding crises driven by a shortage of inpatient psychiatric beds — a problem these home-based pathways are also designed to help ease.

Part of a Broader Push into Decentralized Acute Care

The two trials add to MGB’s existing home-based clinical portfolio, which already includes acute medical admissions and home oncology infusions delivered outside traditional hospital walls. By extending this model to dementia and psychiatric care, the health system aims to decompress inpatient beds at regional academic medical centres while reducing strain on caregivers and easing emergency department bottlenecks.

Key outcomes being tracked across both trials include reductions in delirium, avoided emergency department boarding, hospital bed decompression, and reduced strain on caregivers.