Europe Embraces Hospital-at-Home Wards to Ease Bed Shortages

Some European countries are now addressing persistent hospital overcrowding and bed shortages by sending patients home sooner while continuing to provide them with hospital-level care.

Registered nurse Joanne Hockley, BSc, RN, established one of these “hospital at home” programs in 2018 in the United Kingdom. She believes these programs offer significant benefits. Getting people out of hospital faster frees beds for new patients, providing support to the healthcare system. But it also has physical benefits for many patients.

“They prefer that psychologically, but it also reduces the risks that come from being in a hospital,” she said. “For example, in hospital, they might not get as much sleep, they may not like the meals, and they’re more likely to get pressure ulcers because they’re less mobile and in bed more.”

Getting Creative to Address Real-World Problems

The challenge this model aims to address is real. In 2023, more than 121,000 patients went without a hospital bed in Ireland, making it the worst year for hospital overcrowding on record. In 2024, 1100 patients were left waiting to be admitted to hospitals in Rome and the surrounding region due to “chronically scarce” hospital beds. In the United Kingdom, the number of hospital beds has halved over the last 30 years.

Evidence demonstrates that the benefits described by Hockley are also real. A study published earlier this year showed that a hospital-at-home unit attached to the Hospital Clinic of Barcelona, Barcelona, Spain, saved 1551 bed days, with a readmission rate of only 7%, by facilitating early home transfer for postsurgical patients.

Vittoria Tibaldi, MD, PhD, co-chair of the World Hospital at Home Congress (WHAHC) andsection head of geriatrics at Croce e Carle Hospital of Cuneo in Italy, said hospital-at-home units offer “significant benefits” for patients and health systems.

“In selected patients, hospitals at home can lower the incidence of hospital complications such as delirium, behavioral disturbances, infections, and functional loss, as well as hospital readmissions,” she told Medscape Medical News. “From the health system point of view, the benefits of hospitals at home are represented above all by the potential to lower overcrowding of the emergency department, improving bed rotation, and reducing costs.”

Tibaldi said that hospital-at-home wards might also improve patient quality of life and mood and reduce caregiver stress. Patients and caregivers are typically highly satisfied with this care model, she said — something that Hockley has also seen.

“In the 18 months I worked in the Maidstone and Tunbridge Wells hospital-at-home program, we only had two patients that said ‘no thank you’ to it. Some patients had questions, but once we allayed any concerns and once they were home, there was high patient satisfaction,” said Hockley.

Unlocking Care at Home

According to a 2023 survey at the WHAHC, more than half (52%) the hospital-at-home units that respondents worked in were based in Europe.

These programs rely on remote patient monitoring and daily visits from clinicians, both in person and through telehealth. Family members often assist by handling basic caregiving tasks such as managing medications.

The WHAHC survey found that video communication was used by 63.8% of hospital-at-home programs, while 47.9% offered in-home imaging and 23.4% had advanced procedural capabilities. Most programs included doctor visits to the patient’s home, with nearly all also involving home visits by nurses. Social workers, pharmacists, physiotherapists, and administrative staff can also play a key role in these programs. To be effective, therefore, the hospital-at-home model requires careful integration of logistical and technological factors, as well as a multidisciplinary team to deliver safe and effective care outside the traditional hospital environment.

“Hospital at home is a feasible and safe model of care, but it requires a specific organization; appropriate patient selection; protocols for patient assessment and management; trained, motivated, and dedicated staff; constant psychological and educational support for patients and family members; and constant commitment of the hospital-at-home team in training and research,” said Tibaldi.

She admits that the hospital-at-home model can be complex and may face several challenges, including concerns around reimbursement, regulatory (ie, privacy and patient data security) and consent issues, implementation of technology, and dissemination of the model. Additional challenges include developing standard criteria and guidelines for patient selection and clinical management and ensuring health equity, quality of care, and safety for both patients and staff.

Hockley noted that there might also be some initial discomfort from clinicians who are not accustomed to working within the hospital-at-home model.

Tibaldi agreed that these and other doubts are common and that there are still some misconceptions about the model being too complex, selective, and expensive.

“Despite this, the hospital-at-home model of care is expanding and evolving in many countries around the world,” said Tibaldi. “Hospital at home forces us to always be innovative and creative. Looking forward and constantly engaging in research are our commitment for the future if we want a widespread diffusion of the model.”

Tibaldi and Hockley have disclosed no relevant financial relationships.

Charlotte Waterworth, PhD, is a UK-based freelance medical writer and editor with more than two decades of experience working across a variety of health-related disciplines.