A policy scoping review of how 'Hospitals at Home' can and could support people with dementia

People with dementia are often hospitalised due to comorbidities and superimposed delirium and have poorer outcomes in hospital compared to people without dementia, especially among under-served groups. Hospital at Home (HaH) schemes could reduce these inequalities by facilitating care in a familiar home environment that offers similar outcomes to acute hospital care with lower risks of harms.

We aimed to investigate how dementia and cognitive impairment are considered within English health policy documents informing HaH implementation; considering potential impact on health inequalities and implications for future policy development.

We searched websites, including UK governmental, NHS, social care and professional organisation sources, from 2015; and reference lists of included documents. We thematically analysed documents.

We included 17 documents, comprising clinical guidelines (n = 5), government guidance (n = 4), policy papers (n = 3), service evaluations (n = 3), a strategy document (n = 1) and case study (n = 1). We developed three themes: (i) benefits of HaH for people with dementia, including more person-centred care and familiar treatment environments; (ii) how HaH can be inclusively designed for people with dementia, accommodating needs and mitigating concerns over digital exclusion and safety; and (iii) the critical role of family carers in enabling HaH, including potential carer burden.

HaH models have potential to reduce health inequalities for people with dementia, but current implementation policies risk reinforcing inequalities, particularly among those without digital proficiency or carer support. Future policies should drive consistent inclusive eligibility criteria and processes for ensuring continuity with primary care, dementia care as a HaH staff core competency.