Lead: Mr Mark Tompkins (supervised by Dr Denise Tanner [Social Care], Prof Daniel Lasserson [Acute Care Interfaces])

We are establishing a group of Public Contributors in the Hospitals at Home Society, that will be involved in the project as it develops.

Dates: November 2020 - November 2023

Background:

There are a growing range of approaches both in the UK and internationally that seek to provide acute care to older people in their own home or care home settings. ‘Hospital at home’ initiatives provide diagnostic tests and treatment in the older person’s own home (including care homes), avoiding the need for hospital admission and reducing attendant risks of infection, mental health deterioration and loss of physical function from hospital stays. For older people living in care home settings or their own homes, the need for acute admission to hospital can be distressing and disorientating, especially for people with dementia. The need to free up hospital resources and reduce the risk of exposure to Covid-19 has given added significance to learning about best practice in ‘hospital at home’ interventions that provide ‘care in place’. This has the potential to generate additional care pathways and options, thereby increasing the resilience of the acute care system.

Although acute care aims to be patient-centred, most evaluations of hospital at home services focus on clinical outcomes and processes, rather than the experiences of older people and family carers. Existing research has identified problematic aspects of transitions between hospital and home and harmful iatrogenic consequences of hospital admission for older people, but very little is known about how they experience acute medical care that is delivered in their own home or care home settings. This also has implications for family carers of older people; spousal carers are likely to themselves be older people and frail so it is important to investigate the consequences for them of supporting someone with increased care needs at home.

The Covid-19 pandemic has highlighted the need for social care to be recognised as a valued partner, operating in tandem with NHS care. ‘Hospital at home’ care has considerable implications for social care services and staff and depends on collaboration between social care and health care personnel. It is vital to understand the factors that obstruct and facilitate effective inter-agency and inter-professional practice when providing ‘hospital at home’ care.

Policy and Practice Partners:

TBC.

Co-Funding Partners:

Birmingham City Council, Sandwell and West Birmingham Hospitals Trust, Birmingham Community Healthcare Trust, University Hospitals Birmingham NHS Foundation Trust.

Aims and Objectives:

1. What are the experiences of older people who receive hospital at home services?
2. What are the views and experiences of family carers of being part of a hospital at home intervention?
3. What are the views and experiences of social care staff in providing hospital at home interventions?
4. What are the challenges and opportunities for effective collaboration between social care and health care staff when providing hospital at home service?

Methods:

The study will use qualitative methods, comprising semi-structured interviews and observation. It will also seek to make a methodological contribution to knowledge by exploring different methods of engaging virtually with older people and carers.

Main Results:

Study has only just commenced.

Conclusions:

Not yet known.

Implications for Implementation:

The precise nature of the policy response will be heavily influenced by the findings. By way of example, the healthcare providers are likely to have to work with each other in different ways. Implementation might have to include work to enable different cadres of providers to work effectively together. Work in our Organisational Sciences theme has shown that barriers to inter-disciplinary working frequently result in less impact than expected in health service change.