+AA
Fr

Hospital in the home: After emergency room treatment, follow-up care at home can be an effective and preferred option

The Bottom Line

  • After being treated in a hospital emergency department, many people need after care and treatment by medical professionals.
  • Home care allows people to recuperate in the comfort of their own homes, while receiving treatment by medical outreach staff.
  • A recent research review found that patients receiving home care were more satisfied and did not have any more medical issues or complications than people in hospital. 
  • Citizen contributor Lillian offers a personal perspective on home vs. hospital care 

There’s no place like home – until it’s a medical emergency at which point there’s no place like the hospital. If you suffer an accident or have a sudden, serious health issue the hospital’s emergency department is your immediate recourse. There you can be examined, treated and advised what to do (or not do) to get well.


Then what? Often, subsequent care and treatment involves a hospital stay and that’s where things can get frustrating. In many communities hospitals are operating over capacity, staff are overworked and beds are in short supply (1) which means many patients have to wait for care (2), leading to impatience, worry, discomfort, not to mention the potential for contracting viruses or infections (3). Often you just want to go home where you’re convinced you can recuperate more comfortably and effectively.


According to the research, you may be right. Various types of home care services and supports may be available to provide the follow-up medical care you need, depending on the country, city or community in which you live. A recent review of 22 studies (including 10 randomized controlled trials) examining “Hospital in the Home” services followed the care of thousands of patients who visited the ER in 5 different countries (in Australia and Europe). The most common health issues that brought patients to the ER were respiratory infections, COPD (Chronic Obstructive Pulmonary Disease), bacterial skin infection (cellulitis) and deep vein thrombosis. The home care patients went home directly after receiving initial treatment in the emergency department and received individualized care by nurses as well as other health professionals such as physiotherapists, occupational therapists, social workers and dieticians (5).


What the research tells us

As might be expected, more people were satisfied when they received at-home care compared with people who were admitted to hospital, which is consistent with other studies which demonstrate a strong preference for “hospital in the home” over hospital-based treatment (6).


Importantly, there appeared to be no significant difference in health outcomes, including adverse reactions (for example, to new medications), complications, safety issues and patient death (5). In other words, people who went home to recuperate and receive treatment as needed were not putting themselves at greater health risk than if they stayed in the hospital.


Citizen’s Perspective: How these recommendations might work in practice

Ninety-one year old Lillian has received care both in hospital and at home. In her opinion, home is the preferred option for a few reasons:


People in hospital may hesitate to ask for help when they need it

  •  “In hospital you are one of many other patients. If you are a sensitive person, you may not want to demand too much because it may take services away from others. At home, the focus is on you.”

Home can help us feel more comfortable and less like a ‘patient’

  • “We can feel more comfortable when we are living the lives we are accustomed to, even if we are unwell… When you are in the hospital, all attention is on your illness, but when you are at home, it is easier to think of yourself as a healthy person first.” 

Lillian notes that sometimes care in the home may not be optimal such as:

  • When special equipment and treatments are needed

  • When the home may not provide the circumstances for rest and recovery (for example, if the ill individual is providing care to others in their home, or there is no one living with them who is able or willing to provide support care)

In Lillian’s view, it is important for health care providers to work with families to make decisions about home care.


What do you think?

Which do you think is the preferred option after a health crisis: home care or hospital care? Share your thoughts in the comments box at the bottom of the page.


Get the latest content first. Sign up for free weekly email alerts.
Subscribe
Author Details

References

  1. Forero R, Hillman KM, McCarthy S, et al. Access block and ED overcrowding. Emerg Med Australas. 2010; 22: 119–35.
  2. Derlet RW. Overcrowding in emergency departments: Increased demand and decreased capacity. Ann Emerg Med. 2002; 39: 430–2.
  3. Centers for Disease Control and Prevention (CDC). Healthcare-associated infections[Internet]. Atlanta, (GA). 2015 Jan [cited 2015 Jul]. Available from: http://www.cdc.gov/HAI/surveillance/index.html 
  4. Department of Health &Human Services. Hospital in the home [Internet]. 2014 May 7 [cited 2015 Jul]. Available from: http://www.health.vic.gov.au/hith/
  5. Varney J, Weiland TJ, & Jelinek G. Efficacy of hospital in the home services providing care for patients admitted from emergency departments: an integrative review. Int J Evid Based Healthc. 2014; 12(2):128-141.
  6. Shepperd S, Doll H, Anus RM et al. Admission avoidance hospital at home. Cochrane Syst Rev. 2008; doi: 10.1002/14651858CD007491
  7. Caplan G, Sulaiman N, Mangin D et al. A meta-analysis of ‘hospital in the home’. Med J Aust. 2012; 197(9):512-519.
  8. Deloitte Access Economics. Economic analysis of hospital in the home (HITH) [Internet]. 2011 [cited 2015 Jul]. Available from: http://www.hithsociety.org.au/

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

Want the latest in aging research? Sign up for our email alerts.
Subscribe

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2019 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use