Hospital at Home for older residents with physical deterioration: care home staff experiences

Health and social care systems face rising pressures due to population ageing, rising frailty, multimorbidity and complex care needs. Traditional hospital-based care is increasingly recognised as unsustainable, and may be inappropriate for older adults living in care homes. In England, policy promotes shifting care from acute hospitals to community and residential settings. Hospital at Home (HaH) delivers hospital-level care in a person's usual residence; however, little is known about its delivery and experience within care homes.

This study reports qualitative findings from semi-structured interviews with care home staff, supported by descriptive survey data and open-ended survey responses. Care home staff were recruited from several localities in the South of England. Quantitative survey data were analysed descriptively and qualitative data, thematically.

Fifty participants completed the survey and 20 participated in interviews. Hospital admission remained necessary for some residents, particularly for fractures and acute emergencies. However, hospitalisation was frequently associated with distress, communication breakdowns and hospital-associated decline. In contrast, HaH was perceived to offer benefits including collaborative working, improved continuity, preservation of dignity and comfort and reduced exposure to hospital-related risks. Key barriers included workforce capacity, geographical coverage, limited opening hours and inconsistent referral pathways, restricting timely and equitable access.

Hospital at Home was perceived by care home staff as a valuable and often preferable alternative to hospitalisation for many residents. However, structural and organisational barriers must be addressed to realise its full potential within care home settings. Future research should examine how HaH can be more widely implemented in care homes.