Supporting older people through Hospital at Home care: a systematic review of patient, carer and healthcare professionals’ perspectives

Abstract

Introduction Hospital at Home provides hospital-level type care at home, both remote and face-to-face by a multidisciplinary team of healthcare professionals. In practice, various different models are employed, but we do not know what older people, their family carers (carers) and healthcare professionals think of what works best for them. This review aimed to describe the various Hospital at Home models and synthesise literature exploring patient, carer and staff perspectives of Hospital at Home care for older people. Methods and analysis A systematic review of UK studies. Medline, Embase and CINAHL and grey literature were searched from 1991 to 2024, using predetermined inclusion and exclusion criteria; data were extracted from included papers. Tabulation, thematic grouping and concept mapping of themes were used to narratively synthesise the literature. Results Twenty studies met eligibility. Hospital at Home models included admission avoidance and early discharge. Studies were largely positive regarding Hospital at Home, with benefits including home familiarity, enabling person-centred care and shared decision-making and provision of family carer support. Challenges included staff accessibility, patient and carer anxieties regarding the safety of virtual wards, coordination across sectors and older people using technology. Conclusion Provision of holistic, accessible and continuous care for older people in Hospital at Home services facilitated patient and carer empowerment, dignity and autonomy. There are gaps in our understanding and evidence surrounding paid care workers and informal carers’ perspectives in UK settings, especially within rigorous Hospital at Home literature.