Frequently asked questions

This page will be updated until Spring 2024, when the programme is due to come to an end.

What is the definition of Hospital at Home?
Hospital at Home (H@H) is a short-term, targeted intervention that provides a level of acute hospital care in an individual’s own home, or homely setting that is equivalent to that provided within a hospital. There are a variety of different models and approaches through which such a service can be delivered, but all share certain key features. More detail about the key features of a H@H service can be found on our online toolkit. 

What does 'hospital specialist led' mean?
Hospital specialist led refers to the patient care. Ultimate responsibility and decision making for patients in a H@H service sits with a hospital specialist, as it would in an acute hospital setting. The leadership of the service itself can be agreed locally.

Does a H@H service need to be 24 hours?
No. Most services do not run 24 hours a day. Care of the patients outside of operating hours can, for example, sit with Out of Hours teams. More detail about how services run can be found on the online toolkit. 

What equipment is needed to start a service?
Equipment required will depend on the range of interventions being delivered and skill mix of staff involved in the service.

This list of equipment to consider when starting a service is a useful guide.

What is the evidence for H@H?
A literature review of the published evidence on the overall effectiveness and safety of Hospital at Home initiatives for older people with frailty was undertaken to discover any lessons that can be learned on what works, for whom and why. The key points from the review and the supporting evidence are summarised below. You can read more about the evidence for H@H on the toolkit.

The emerging evidence on effectiveness and safety suggests that compared with usual hospital care:

• Costs of H@H are generally lower than inpatient care, but there can be considerable variation in costs between services. H@H services have the potential to be a cost-effective option.
• Patients generally express high levels of satisfaction with the service.
• H@H may reduce the likelihood that patients will be living in residential care in the months after the acute episode, and
• H@H can be delivered safely without increased rates of death or re-admission to acute care.

Is H@H an acute or a community service?
H@H is delivered by acute specialists, however, due to the nature of providing care in the home it uniquely sits at the interface and commissioning of a service should ideally take place within the Integrated Joint Board.
A H@H service serves people within the community, and should therefore align with existing services such as virtual wards, community teams and enhanced community teams.
In some areas H@H is delivering a service which bridges acute and community care – with models being developed where clinicians follow their patients across traditional acute/community divides. H@H should be patient focused rather than service led.

What is the expected time commitment?
The time commitment to set up a service is mostly through engagement with key stakeholders such as service users to raise awareness of the service, and to find out the needs of the population. Engagement should focus on providing a service which complements existing services both within the community and acute sector to develop seamless links and pathways.

How important is it for H@H to link with primary care?
It is vital for a H@H service to build relationships and engagement with primary care to ensure effective communication, especially as there may not be linked IT systems. Clear referral criteria are key to running a successful service, with clear referral pathways into other services to ensure seamless transition and clear communication. Clear pathways and strong relationships ensure each patient gets the best individualised care.
Successful services demonstrate the ability to maintain contact with GPs, ensuring that any important clinical information is relayed in a timely manner, including a detailed discharge letter with an updated medicines reconciliation. 

What does a H@H caseload/ward look like?
This can vary between services. There are also a range of blogs, case studies and information summaries available on our toolkit. 

Where can I find examples of existing services and protocols?
Teams across Scotland have shared examples of service design, SOPs, and guidance. These can all be found on out online toolkit. New resources developed by teams are also shared on the Hospital at Home Microsoft Teams Community. Find out how to join the community and other ways of connecting with services by going to the online toolkit. 

Who does a H@H team comprise of?
This changes depending on the needs of the service, how long it has been operating for and what other services exist locally. Visit our online toolkit where you can find out more about the workforce in H@H services. 

How can I demonstrate that H@H is a viable, sustainable option?
You may wish to run a small pilot and focus on a particular area where you are planning to launch the pilot. For example, a geographical area with a high hospital admission referral rate or a group of patients that require admission regularly.

Experience of existing teams tells us that it is best to start small and then develop as you progress in order to shape your service to the needs of your population, followed by a gradual roll out to encompass your designated area.

What impact does H@H have on care at home services?

H@H requires the support of care providers to safely manage patients at home. These patients are at high risk of admission and it it is vital that connections are made with social work.

There may be concerns that using care at home may increase referrals to their service, however, experience in existing services shows that this is not necessarily the case. Working with care providers can ultimately allow autonomy for the patient to stay at home in contrast with patients discharged from an inpatient stay in hospital who may require a greater package of care due to institutionalisation.

Experience also shows that patients who are kept at home do not lose their existing care packages, as this can be continued while the patients are under the care of H@H.