Posted: April 29th, 2018

Home-based care vs hospital based care

Home-based care vs hospital based care

Home-based care, also known as hospital at home, is an alternative to hospital admission for some older people who experience a deterioration in health due to acute functional decline or infection. In this model, patients receive hospital-standard care in their homes, provided by a geriatrician and a multi-disciplinary team, with access to medicines, oxygen and intravenous treatment. Patients can be transferred to hospital if required.

Hospital based care is the conventional approach of admitting older patients to hospital wards, where they receive medical and nursing care, diagnostic tests and treatments. Hospital admission may be necessary for some patients who need intensive or specialist care, but it may also have negative consequences for older people, such as acute confusion (delirium), reduced mobility and increased risk of infection.

In this blog post, we will compare and contrast the advantages and disadvantages of home-based care and hospital based care for older people, based on the latest evidence from research studies.

Advantages of home-based care

– Home-based care may improve patient outcomes, such as living at home, avoiding long-term residential care and developing delirium. A recent study funded by the NIHR showed that caring for a select group of vulnerable, older people at home can be just as good, or even better, than hospital care [1]. The study found that after six months, there was little difference in the proportion of participants living at home (78.6% vs 75.3%) or who had died (16.9% vs 17.7%) between the home-based care and hospital based care groups. However, participants in the home-based care group were slightly less likely to be in long-term residential care (5.7% vs 8.7%) or to develop delirium after one month (1.7% vs 4.4%).
– Home-based care may increase patient satisfaction and preference. Surveys have consistently found that most older people prefer to receive care at home rather than in hospital [2]. Home-based care may allow patients to maintain their independence, dignity and comfort in familiar surroundings, while receiving personalised and holistic care from a dedicated team. Home-based care may also reduce the disruption and stress caused by hospital admission, such as separation from family and friends, loss of routine and exposure to unfamiliar environments and staff.
– Home-based care may reduce pressure on hospital resources and budgets. Hospital admission is costly and often leads to longer lengths of stay and readmissions for older patients [3]. Home-based care may reduce the demand for hospital beds and free up space for other patients who need urgent or specialist care. Home-based care may also reduce the costs of transportation, equipment and staff training associated with hospital based care.

Disadvantages of home-based care

– Home-based care may not be suitable or available for all older patients. Some patients may have complex or unstable medical conditions that require intensive or specialist care in hospital settings. Some patients may not have adequate home environments or support systems to receive home-based care safely and effectively. Some patients may not consent to or comply with home-based care due to personal preferences or concerns. Home-based care may also depend on the availability and capacity of local services, staff and resources, which may vary across different regions and settings.
– Home-based care may pose challenges for quality assurance and coordination of care. Home-based care involves delivering hospital-standard care in diverse and dynamic home settings, which may pose difficulties for ensuring quality, safety and consistency of care. Home-based care may also require effective communication and collaboration among different providers, such as primary care physicians, geriatricians, nurses, therapists, pharmacists and social workers, who may have different roles, responsibilities and expectations. Home-based care may also involve sharing information and decision making with patients and their families or carers, who may have different levels of health literacy and involvement.
– Home-based care may have unintended consequences for patients and their families or carers. Home-based care may increase the burden and responsibility of family members or carers who provide informal support to older patients at home. Family members or carers may have to adjust their work schedules, lifestyles and personal needs to accommodate the patient’s needs and preferences. Family members or carers may also experience emotional stress, anxiety or guilt related to the patient’s condition or prognosis. Home-based care may also affect the patient’s social relationships and activities outside the home, such as isolation from peers or community groups.

Conclusion

Home-based care and hospital based care are two different models of providing health care to older people who experience a deterioration in health due to acute functional decline or infection. Both models have advantages and disadvantages that depend on various factors, such as patient characteristics, preferences and needs; home environment and support system; availability and quality of services; cost-effectiveness; outcomes; satisfaction; etc.

There is no one-size-fits-all solution for choosing between home-based care and hospital based care. Each patient should be assessed individually and offered the most appropriate and feasible option for their situation. More research is needed to compare the effectiveness, efficiency and equity of home-based care and hospital based care across different settings and populations.

References

[1] Shepperd S, Cradduck-Bamford A, Butler C, et al. A Randomized Trial of Hospital in the Home for Older Patients. Ann Intern Med. 2021;174(7):894-904. doi:10.7326/M20-5047
[2] Leff B, Burton L, Mader SL, et al. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med. 2005;143(11):798-808. doi:10.7326/0003-4819-143-11-200512060-00008
[3] Conroy SP, Stevens T, Parker SG, Gladman JR. A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’. Age Ageing. 2011;40(4):436-443. doi:10.1093/ageing/afr060

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