Could bringing the hospital home expand acute care capacity?

Despite its numerous advantages and benefits, developing and executing a Hospital at Home (HaH) service that offers a true alternative to a standard hospital admission remains elusive in Canada.

Running a HaH program isn’t cheap: staff to patient ratios can be double the ones of the hospital; staff transportation and remote monitoring technologies also add to the operating costs. These operating costs are certainly justified when HaH functions as an acute care service, offering an alternative to a standard hospital admission. Unfortunately HaH programs have a tendency to intervene well past the acute phase and become little more than a glorified, albeit very expensive, discharge to home program. An example of this is the HaH program in Victoria BC, where patients are identified and taken charge while already hospitalized, past their acute phase, allowing them to complete their therapies at home while supervised. Despite the benefits of returning patients home a few days early, this type of program is unlikely to be cost-effective or even qualify as a true HaH program, for three reasons. First, despite the high operating costs of what should be an acute care service it operates as a post-acute one. Second, the Canadian healthcare system already has many post-acute care programs and services, some of which have been operating for decades, such as the home IV program. Any other post-acute program risks duplicating them, even if they bear the name of HaH. Third, by not intervening early enough in the care continuum, in the acute or pre-acute phase, HaH remains unable to avert a hospital admission which is its very raison d'être.

Various jurisdictions in Canada may fail to see the true value of HaH if they end up designing and implementing what turns out to be a service that duplicates existing ones, with high operating costs and without being able to avert a hospital presentation / admission in the first place. In order to avoid this, it would be essential for any HaH to remain in the acute phase of the care continuum, which would translate into taking charge of a patient much sooner, while they are still in the ER or while still in the community (pre-acute phase). Taking inspiration from some successful examples such as the one in Bristol (UK) which is embedded within their ambulance service, would ensure HaH offers a true substitute to a standard hospital admission and not just an enhanced discharge service.