The British Geriatrics Society has published a new report ‘Bringing hospital care home: Virtual Wards and Hospital at Home for older people.’ It explores the potential benefits, limitations, and current scientific evidence to be considered when providing a safe, effective, and person-centred alternative to hospital inpatient care for older adults.
Here’s the Introduction
In recent years, healthcare professionals have been considering new ways to respond to the acute care needs of older people with frailty and other long-term conditions. Urgent care is needed but hospitals bring risks for older people as well as benefits, and community-based alternatives are increasingly being explored. This has resulted in a shift in focus within the NHS and internationally towards providing hospital-level care in a person’s home environment.
While these services are traditionally referred to as ‘Hospital at Home,’ a broader programme of work has recently been introduced by NHS England using the term ‘Virtual Wards’. This includes models based on remote monitoring and advice as well as the face-to-face care provided by Hospital at Home models. The different models have the same aim – to provide a safe, effective and person-centred alternative to hospital inpatient care.
Hospital at Home is the most commonly used term to describe these services, both in the UK and overseas. Hospital at Home is delivered as a time-limited face-to-face service by healthcare professionals visiting patients at home. The term ‘Virtual Wards’ can cause some confusion as many people assume the word ‘virtual’ to mean ‘remote’ or ‘online’. Virtual Wards have also been treated separately from Hospital at Home by health researchers. However, within the NHS England model, Virtual Wards for older people operate in a similar way to Hospital at Home, with the vast majority of care being face-to-face.
For many older people, hospital admission presents a risk of harms such as deconditioning, delirium and hospital-acquired infections. Receiving treatment and rehabilitation at home may be beneficial, and preferable to hospital admission or to a longer inpatient episode.
Many BGS members have been involved in providing an urgent community response and intermediate care services at home for some years, as described in our Right Time, Right Place
These are time-limited multidisciplinary services that offer urgent community assessment, treatment, rehabilitation and support as ‘step up’ or ‘step down’ from acute hospital care. Specialist practitioners working in intermediate care services often provide some short-term intensive hospital-level care too.
In many parts of the country, health and care systems are actively encouraged to establish services that provide hospital-level care to people in their homes. Yet some BGS members have told us that it is unclear how Virtual Wards and Hospital at Home services are being funded and introduced in England. They have asked for information on how these new models of care are being implemented in different areas and how they can be developed in a way that adds value to established intermediate care and urgent community response services for older people.
This paper will summarise the current landscape from the perspective of healthcare for older people and provide some advice to BGS members looking to set up Virtual Wards for older people living with frailty. It is important to note that Virtual Wards and Hospital at Home are not exclusive to older people and can be used to care for a range of population groups with different health conditions. As the BGS is solely concerned with older people’s healthcare, this paper discusses Virtual Wards and Hospital at Home within that context only.
While there are many different names for these new services, for the purposes of this paper, we will use the term ‘Virtual Wards’.