Older people and unpaid carers’ experiences of ‘Hospital-at-Home’

Tompkins, Mark (2025). Older people and unpaid carers’ experiences of ‘Hospital-at-Home’. University of Birmingham. Ph.D.

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Abstract

Hospital at Home (HaH) is designed to provide acute care for unwell individuals within the comfort of their homes, be it their own home or a care home, mirroring the level of care found in hospital settings. This model is specifically tailored for older people living with frailty, who may be adversely affected by traditional hospital stays. It aims to conduct assessments and interventions at home by healthcare professionals equipped with the necessary training, diagnostic and treatment tools. This approach seeks to avert unnecessary transfers to emergency departments by facilitating early access to senior medical intervention and evaluation, especially for those who may later require enhanced care. Such a strategy is expected to enhance outcomes for those accessing acute care, enrich patient experiences, and alleviate crowding in emergency departments.

This initiative is part of a broader research programme deeply influenced by individuals with firsthand experience of the system. It incorporates a panel comprising individuals who have received adult social care and their supporters, guiding the methodology for public and patient engagement. The goal of the study was to learn about the perspectives of older people who receive HaH, their unpaid carers who are involved in their relatives' HaH, and health and social care workers who provide HaH, as well as the challenges and opportunities for effective collaboration between social care and health care workers.

The study involved 43 participants in a qualitative exploration using a phenomenological framework, encompassing older people, unpaid carers, and health and social care staff. Purposeful sampling was used to identify and select information-rich cases related to the phenomenon of interest: older people, their unpaid carers accessing HaH, and the professionals delivering it. Each participant participated in a semi-structured interview lasting up to 60 minutes, allowing them to respond in their own words. This contrasts with previous HaH studies in the United Kingdom (UK) that rely on fixed yes or no responses in surveys or questionnaires. Inductive thematic analysis was used to analyse the data.

The findings may create learning opportunities for an international audience, for example, concerning effective interprofessional working and person-centred care in HaH. Key discussion areas include the importance of the carer role in HaH, the influence of environment and place on care experiences, and the need for better integration across statutory, private, and third-sector services. Many of the themes discussed relate to different dimensions of quality of care, particularly how it is perceived and delivered. Notably, communication emerged as a critical concern, especially regarding the transition from HaH to general practitioner (GP) care, an area requiring more effective systems and protocols.

This study also explored both expected and unexpected results and their significance for shaping future health and social care policy and practice. The discussion connects research findings to existing literature while identifying study limitations and suggesting additional research questions that address the complex and evolving nature of HaH. Future directions include exploring new avenues for improving person-centred delivery, carer support, integrated care pathways, and communication strategies in community-based services.

The following steps will be to give feedback to the local site in England where the research has taken place and to the Applied Research Collaboration (ARC) that has funded the study. This will highlight ideas and improvements for the future of community-based health and social care for older people and their carers.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):