Hospital at Home-What does the evidence tell us?

Hospital at Home (HaH) has emerged internationally as an effective model of healthcare delivery for older adults, providing care within patients' homes as an alternative to inpatient admission when appropriate. Since the COVID-19 pandemic, there has been rapid expansion of HaH services, of which older people are the majority users. This collection in Age and Ageing journal brings together contemporary evidence examining the evolution, effectiveness, implementation and experience of HaH care for older people. The papers highlight the heterogeneity of HaH models, ranging from admission avoidance and early supported discharge services to comprehensive geriatric assessment-based multidisciplinary care. Collectively, the evidence suggests that well-supported HaH models can achieve outcomes comparable to inpatient care, with evidence supporting cost-effectiveness and reduced care home admission, whilst improving patient experience and increasing time spent living at home. Importantly, the collection also explores the complexities underlying HaH implementation. Several papers demonstrate that successful HaH depends not only on technology, but on multidisciplinary clinical expertise, coordination across services and substantial contributions from informal caregivers. Challenges relating to workforce capacity, digital exclusion, caregiver burden and service integration remain significant.