Module 2 - Initiating care in the home
In this module, you will explore how Hospital at Home care is initiated and what needs to be considered when hospital-level treatment moves into the patient’s home. The module follows the patient’s pathway into Hospital at Home and highlights the importance of assessing the home as a care environment. You will also focus on the first encounter in the home, including how to establish trust, identify risks, and create a shared understanding of the care plan. The module addresses safety and security for both patients and healthcare professionals, and considers how family caregivers can support care while also having their own needs and limitations.
The patient’s pathway into Hospital at Home
This chapter introduces preparation and admission in Hospital at Home, focusing on how patients are identified, assessed, and safely onboarded. The chapter also highlights how clear information, technology testing, daily contact, and shared care planning create a safe start to treatment at home.
Preparation and admission
Before a HaH pathway can begin, the question must be considered: “Is this patient suitable for care in their own home?” This often requires a proactive approach from HaH staff to encourage colleagues and collaboration partners to consider HaH as a viable option. Over time, this can contribute to a culture in which HaH is routinely considered for relevant patients.
An important part of patient selection is the use of inclusion and exclusion criteria. Inclusion criteria may relate to clinical needs, geographical factors, or logistical conditions, but the most important criteria are:
The patient wishes to receive care at home
The patient’s care needs can be met at home
The patient is likely to benefit from receiving care at home than in hospital
Exclusion criteria may include cognitive impairment, lack of support in the home, or a high risk of falls.
The question of suitability for HaH may arise at several points within the healthcare system, such as in general practice, in the emergency department, during home visits, or after a patient has already been admitted to hospital. The pathway through which a patient is enrolled depends on local organisation and collaboration with primary care and municipal services.
Hamid
Hamid, 78, has chronic heart failure, hypertension, and reduced mobility. He uses a rollator and receives support from municipal home care, including help with compression stockings. Recently, he has developed increasing leg swelling, greater difficulty standing up, and reduced walking ability. His vital signs are initially stable, but his symptoms suggest a risk of worsening heart failure, fluid retention, and falls.
Hamid is considered for Hospital at Home because he needs continued monitoring, adjustment of diuretic treatment, and support with daily assessments, but he prefers to remain in his own home. Before admission, the team assesses whether his care needs can be met safely at home, including his mobility, ability to follow instructions, home environment, and available support.
Although Hamid may benefit from HaH, his reduced mobility, leg oedema, and need for help with compression stockings are important risk factors. If his fall risk is high, if swelling and breathlessness worsen, or if he requires more frequent supervision than the HaH team can provide, hospital care may be safer. His case shows why preparation and admission must include both clinical assessment and careful evaluation of the patient’s everyday situation at home.
Onboarding and a safe start
When a patient is admitted to HaH, many of the same steps are followed as in admission to a conventional inpatient ward, including review of medical history, clinical background, and medication lists. However, there are also specific aspects that require particular attention.
If the HaH model is new to the patient, it is important to provide a clear introduction. This includes explaining how the technology works, how care will be delivered, and what to do if the patient’s condition changes or if equipment does not function as expected. This process is often referred to as onboarding.
It is beneficial for patients to test the technology at the time of admission. This allows potential issues to be identified, questions to be addressed, and a sense of confidence and security to be established. Onboarding can also help strengthen the relationship between the patient and the healthcare team and provides an important foundation for the subsequent care pathway.
Admission is typically managed by staff from the office and/or the mobile teams, who have the necessary equipment and expertise to ensure a safe and effective start to treatment in the patient’s home.
Once admitted to HaH, the care pathway is typically organised around six core principles:
The majority of treatment time is spent in the patient’s home
Care is delivered by an interdisciplinary team
The patient has daily contact with healthcare professionals, either in person or digitally
A treatment plan is developed collaboratively with the patient
The patient has access to care around the clock
Sampling and treatment are primarily carried out in the home
The home as a care environment
How do care, treatment, and collaboration function when they take place in the patient’s own home?
A new care environment
HaH does not merely relocate care from the hospital—it also reshapes relationships, responsibilities, and collaboration. When the home becomes a setting for treatment, healthcare professionals, patients, and relatives together shape the framework of care. For many healthcare professionals, this way of working can feel more meaningful, as it brings them closer to patients’ everyday lives and needs, enabling more tailored care and more precise clinical assessments.
The home is a central part of people’s lives and, for many, is associated with feelings of safety, control, and privacy. It is a place for everyday life and social connection—but in HaH, it also becomes a setting for advanced treatment and clinical decision-making. As care moves into the home, both the patient’s role and the character of the home change. Clinical quality and professional satisfaction may increase when care is perceived as relevant and adapted to the individual patient.
From a personal perspective
For some patients and relatives, remaining at home is experienced as reassuring and motivating. For others, it may feel intrusive—both physically and emotionally—when the home is filled with medical equipment and unfamiliar professionals. This may give rise to new dilemmas: How is privacy preserved? How is the home maintained when it also functions as a workplace?
From a professional perspective
As a healthcare professional, you must navigate the home’s dual role with sensitivity and respect for the person and environment you are entering. Working in patients’ homes places high demands on adaptability and the ability to develop creative, patient-safe solutions. It may also be experienced as a trust-based way of working, which can strengthen relationships but requires clear structures and support from management and colleagues to ensure safety in practice.
It also requires the ability to plan how care and treatment can be delivered in the home, taking into account the necessary competencies, coordination, and collaboration. At the same time, you need an understanding of how the roles of patients and relatives evolve, and how you, as a healthcare professional, can support safe and high-quality care in this setting.
Hamid
During a home visit, the nurse notices that Hamid’s compression stockings are lying on the floor beside his armchair. Hamid explains that he could not stand long enough to put them on, and that his legs feel more swollen than usual.
From a professional perspective, the nurse must assess more than Hamid’s vital signs. She needs to consider how treatment can actually be carried out safely in his home: Can he manage to move around in his house without support? Does he need additional assistive devices? Should home care visits be adjusted? Is there a need for physiotherapy or occupational therapy input?
Hamid’s case shows how care in the home requires clinical judgement, adaptability, and coordination. The professional must respect Hamid’s wish to remain at home, while also ensuring that the home environment, available support, and care plan are safe enough for continued treatment.
Safety and security in the patient’s home
Providing care in the patient’s home means that, as a healthcare professional, you are working in an environment that cannot be fully controlled. This may create a sense of uncertainty, even though serious incidents are rare. In this section, the focus is on safety and the working environment for staff in HaH.
Most home visits take place without incident, and situations involving threats or violence are uncommon. Nevertheless, some staff may experience discomfort when working alone in private homes—particularly in cases involving unfamiliar patients, complex social circumstances, or geographically isolated areas.
It is important to be prepared to manage situations that may feel unsafe. This includes both preventive measures and knowing how to respond if a situation arises. For example, this may involve:
Scheduling visits at times when support is more readily available
Bringing a colleague when there is uncertainty
Assessing risk based on medical records or previous incidents
Having access to designated contacts or emergency assistance
Communicating openly within the team about experiences and personal boundaries
Feeling safe at work is a prerequisite for providing high-quality care. The working environment and staff safety should therefore always be taken seriously—even in HaH, where the workplace is someone else’s home.
The first visit in the home
This chapter introduces the home visit as a central part of Hospital at Home. The chapter explores how healthcare professionals balance clinical tasks with independence, flexibility, safety, privacy, and person-centred support when delivering care outside the hospital.
The home visit
In the HaH model, care is delivered both digitally and in person, with most practical tasks carried out by mobile teams and, in some cases, external collaborators—primarily in the patient’s own home. The working environment differs significantly from that of a hospital and requires attention to ergonomics, adaptability, and safety. All tasks must be performed with respect for both patient safety and privacy.
Common reasons for home visits include:
Clinical examinations
Monitoring of vital signs
Medication administration (e.g. intravenous therapy and infusions)
Wound care and dressing changes
Diagnostic procedures (e.g. ultrasound, X-ray, ECG)
Sampling and analysis
Patient education and counselling
Nursing procedures, such as the management of feeding tubes and peripheral venous catheters (PVC)
Although healthcare professionals are often experienced and confident in hands-on clinical tasks—many of which resemble hospital-based routines—the context changes markedly. In hospital settings, there is immediate access to colleagues, equipment, and specialised services. In the patient’s home, or when travelling between visits, healthcare professionals must work more independently and be prepared to manage unexpected situations.
Reasons for a home visit
Clinical examinations and diagnostics
Certain diagnostic and radiological examinations can now be performed in the home. Mobile ultrasound devices enable both diagnosis and follow-up of treatment wherever the patient is located. In the future, additional mobile diagnostic solutions may become available.
Sampling
Blood, and other forms of sampling, are common procedures and often performed during home visits. Different approaches may be used: healthcare professionals may collect samples in the home and transport them to the hospital for analysis, or samples may be analysed directly in the home using portable equipment, depending on available resources and clinical needs. In some cases, patients may also perform self-testing and analyses at home.
Medication administration
Medication administration in HaH includes treatments such as oral medication, injections, and intravenous therapies delivered in the patient’s home. Technical solutions may support medication management, including infusion pumps and elastomeric devices for continuous delivery. Medication administration in HaH also places greater emphasis on patient and relative involvement. This requires clear instructions, education, and ongoing support, as well as appropriate monitoring.
Nursing care
Nursing care in the home encompasses a wide range of activities, including personal care, symptom management, and support with daily living. It combines advanced clinical tasks with holistic, patient-centred support. Care is adapted to the individual’s needs, living conditions, and daily routines, which can enhance comfort, involvement, and continuity. This approach may strengthen patients’ ability to manage their condition and contribute to a greater sense of safety and participation in their own care.
Vital signs monitoring
Monitoring of vital signs is a key component of HaH and may be carried out by healthcare professionals or by patients themselves using digital devices. This can include measurements such as blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature, as well as condition-specific parameters (e.g. weight monitoring in heart failure).
Monitoring may be performed intermittently or continuously through remote monitoring systems that transmit data to healthcare professionals in real time. This enables early detection of clinical deterioration and supports timely intervention.
Education and counselling
Education and counselling aim to support patients and their relatives in understanding the condition, treatment plan, and use of medical equipment. Clear communication and guidance are essential to promote self-management, safety, and confidence in the home setting.
Family caregivers as a resource
This chapter introduces family caregivers as an important resource in Hospital at Home. It highlights their practical and emotional role, while emphasising that involvement must be voluntary, realistic, and supported.
Family caregiver – an essential resource in care
Family caregivers already provide a substantial proportion of care and support in society. It is estimated that around half of all care-related activities in Europe are carried out by family caregivers. When care is delivered in the home, their role often becomes more visible and significant.
Their contribution may be both practical and emotional and, in many cases, is crucial in enabling the patient to remain at home. At the same time, it is important to emphasise that family caregivers should never be regarded as an implicit prerequisite for treatment. Their involvement must always be voluntary, and careful consideration should be given to their own resources and needs.
Family caregivers may also require support. They can experience responsibility, worry, and strain—particularly when the home is also their own living space. It is therefore important to involve them thoughtfully and to offer support and guidance where appropriate. When relevant, and in accordance with confidentiality and data protection regulations (e.g. GDPR), family caregivers may be involved in care planning and delivery.
Working in the patient’s home can provide a more nuanced understanding of the patient’s life situation. It may also bring attention to signs of risk, such as violence, abuse, or mental illness—circumstances that require careful assessment and appropriate professional action. Where children are involved and concerns arise, healthcare professionals have a duty to notify the relevant social services.
Stina
Stina, 85, lives with her husband, who is her main source of support. When she becomes acutely unwell with fever, worsening leg swelling, shortness of breath, and pain after a fall, he is the one who notices that the situation has changed and contacts emergency services. His knowledge of Stina’s usual condition is important for the HaH team’s assessment.
If Stina is admitted to HaH, her husband may help by observing changes in her condition, supporting her with meals and medication routines, and contacting the team if she becomes more breathless, confused, or less mobile. However, he is also elderly and becomes increasingly worried and tired. His involvement must therefore be voluntary and realistic.
Stina’s case shows that family caregivers can be an essential resource in HaH, but they should not be treated as unpaid healthcare staff. The team needs to include her husband in planning where appropriate, give clear information about when and how to seek help, and assess whether he also needs support. This helps protect both Stina’s safety and her husband’s wellbeing.
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